Pre-Exposure Prophylaxis in Trans Populations: Providing Gender-Affirming Prevention for Trans People at High Risk of Acquiring HIV

LGBT Health ◽  
2018 ◽  
Vol 5 (7) ◽  
pp. 387-390 ◽  
Author(s):  
Madeline B. Deutsch
Author(s):  
Ketil Slagstad

AbstractThis article analyzes how trans health was negotiated on the margins of psychiatry from the late 1970s and early 1980s. In this period, a new model of medical transition was established for trans people in Norway. Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease. By using archival material, medical records and oral history interviews with former patients and health professionals, I demonstrate how social aspects not only underpinned diagnostic evaluations but were an integral component of the entire therapeutic regime. Sex reassignment became an integrative way of imagining and practicing psychiatry as social medicine. The article specifically unpacks the social element of these diagnostic and therapeutic approaches in trans medicine. Because the locus of intervention and treatment remained the individual, an approach with subversive potential ended up reproducing the norms that caused illness in the first place: “the social” became a conformist tool to help the patient integrate, adjust to and transform the pathology-producing forces of society.


2015 ◽  
Vol 12 (1) ◽  
pp. 168-179 ◽  
Author(s):  
Laurence Claes ◽  
Walter Pierre Bouman ◽  
Gemma Witcomb ◽  
Megan Thurston ◽  
Fernando Fernandez‐Aranda ◽  
...  

2021 ◽  
Author(s):  
Terrence Abrahams

In the introduction to Troubling the Line: Trans and Genderqueer Poetry and Poetics, editor TC Tolbert states that the cultural work of this anthology is, in part, “an attempt to expand the range of what is possible for trans and genderqueer poets and to acknowledge that there is no such thing as monolithic trans and genderqueer poetry” (10). Tolbert further notes that there are two dangers to producing an anthology that will, undoubtedly, shift literary culture: they are exclusion and isolation or confinement (11). Tolbert and fellow editor Trace Peterson are both aware, then, that as a burgeoning field of study and literary culture, transgender poetry and poetics simply cannot be defined, lest they perpetuate exclusion (a state with which trans writers are most familiar) and isolation (Tolbert here cites a “biographical frame [that] puts more emphasis on the author ... than the actual poems” - but the editors are also rightly concerned that only other trans people will be interested in trans poetics, meaning cisgender readers will overlook these works [11]).


Urology ◽  
2021 ◽  
Author(s):  
Jonathan Guy Bensley ◽  
Ada S. Cheung ◽  
Mathis Grossmann ◽  
Nathan Papa

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035689
Author(s):  
Anna Larsen ◽  
Kate S Wilson ◽  
John Kinuthia ◽  
G John-Stewart ◽  
BA Richardson ◽  
...  

IntroductionAdolescent girls and young women (AGYW) in sub-Saharan Africa are at high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) demonstration projects observe that AGYW uptake and adherence to PrEP during risk periods is suboptimal. Judgemental interactions with healthcare workers (HCW) and inadequate counselling can be barriers to PrEP use among AGYW. Improving HCW competency and communication to support PrEP delivery to AGYW requires new strategies.Methods and analysisPrEP Implementation for Young Women and Adolescents Program-standardised patient (PrIYA-SP) is a cluster randomised trial of a standardised patient actor (SP) training intervention designed to improve HCW adherence to PrEP guidelines and communication skills. We purposively selected 24 clinics offering PrEP services under fully programmatic conditions in Kisumu County, Kenya. At baseline, unannounced SP ‘mystery shoppers’ present to clinics portraying AGYW in common PrEP scenarios for a cross-sectional assessment of PrEP delivery. Twelve facilities will be randomised to receive a 2-day training intervention, consisting of lectures, role-playing with SPs and group debriefing. Unannounced SPs will repeat the assessment in all 24 sites following the intervention. The primary outcome is quality of PrEP counselling, including adherence to national guidelines and communication skills, scored on a checklist by SPs blinded to intervention assignment. An intention-to-treat (ITT) analysis will evaluate whether the intervention resulted in higher scores within intervention compared with control facilities, adjusted for baseline SP scores and accounting for clustering by facility. We hypothesise that the intervention will improve quality of PrEP counselling compared with standard of care. Results from this study will inform guidelines for PrEP delivery to AGYW in low-resource settings and offer a potentially scalable strategy to improve service delivery for this high-risk group.Ethics and disseminationThe protocol was approved by institutional review boards at Kenyatta National Hospital and University of Washington. An external advisory committee monitors social harms. Results will be disseminated through peer-reviewed journals and presentations.Trial registration numberNCT03875950


2017 ◽  
Vol 22 (25) ◽  
Author(s):  
Alison E Brown ◽  
Hamish Mohammed ◽  
Dana Ogaz ◽  
Peter D Kirwan ◽  
Mandy Yung ◽  
...  

Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014–September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.


2019 ◽  
pp. 135910531988392
Author(s):  
Marion Di Ciaccio ◽  
Luis Sagaon-Teyssier ◽  
Christel Protière ◽  
Mohamed Mimi ◽  
Marie Suzan-Monti ◽  
...  

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent ( p < 0.001) of participants perceiving low risk and 100 per cent ( p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent ( p < 0.001) and 99.8 per cent ( p < 0.001), respectively, reported low-level condom use.


2019 ◽  
Vol 31 (3) ◽  
pp. 259-272 ◽  
Author(s):  
Costanza Puppo ◽  
Xavier Mabire ◽  
Laurent Cotte ◽  
Daniela Rojas Castro ◽  
Bruno Spire ◽  
...  

ANRS-IPERGAY was a community-based randomized trial investigating the efficacy of sexual activity-based HIV pre-exposure prophylaxis (PrEP) in a population of males and transgender females who had sex with men and were at high risk of HIV infection. We qualitatively analyzed the support provided to participants by community-based health workers (CBHW) throughout the trial's double-blind and open-label extension phases. In particular, we showed that the relationship between participants and CBHW strongly influenced self-managed pill intake. The delicate construction of this relationship, balanced between trust and dependence, played an important role in PrEP adherence. CBHW had to deal with various issues surrounding participants' feelings of empowerment regarding their role in the trial, as well as related tensions between various logics and rationalities. They were essential to participants' continued involvement.


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