scholarly journals Stigma and HIV service access among transfeminine and gender diverse women in South Africa – a narrative analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Laing de Villiers ◽  
◽  
Angelique Thomas ◽  
Dionne Jivan ◽  
Graeme Hoddinott ◽  
...  
Keyword(s):  
South Africa ◽  
Gender Identity ◽  
Narrative Analysis ◽  
Service Access ◽  
Gender Diverse ◽  
Related Stigma ◽  
Male Sex ◽  
And Gender ◽  
Sex With Men ◽  
Living With Hiv

Abstract Background Transgender women have a disproportionately high HIV prevalence compared to cisgender women and men who have sex with men, which puts them at risk of HIV-related stigma (Baral SD et al., Lancet Infect Dis, 13;3, 2013). People whose gender identities are in tension with dominant social norms (including transgender women) often also experience gender identity-related stigma. There has been increasing attention to transgender people in HIV research and interventions. However, very little research has been done in sub-Saharan African countries. Methods We conducted a qualitative cohort study which included eight transfeminine and/or gender diverse women (four living with HIV) in Western Cape, South Africa, for a follow-up period of 12–18 months. Using a narrative analysis approach, we set out to understand how transfeminine and gender diverse participants in the cohort anticipated, experienced and internalised HIV stigma and gender identity stigma, and how these stigmas affected HIV service access. Result We found that participants reported anticipated, experienced, and internalised stigma relating both to their gender identity and to living with HIV. Participants reported inconsistent uptake of antiretroviral therapy (ART) services (including ART initiation and adherence) that they linked to stigma. We also found that gender diverse women and transfeminine women are challenged with other stigmatising social identities, like being a sex worker, drug user and/or a man (or assigned male sex at birth) who have sex with men (MSM). We use the terms ‘transfeminine’ and ‘gender diverse’ as terms that are inclusive of gender variant people who were all assigned male sex at birth and identify as women in some or all aspects of their lives. The persons in our study also showed gender identifications that were fluid and sometimes varied in different contexts and situations, therefore gender identity and sexual identity were often conflated for these individuals. Participants managed high levels of reported stigma by drawing on social support networks like families, friends and peers. Conclusion Our study provides exploratory work on how stigma may affect HIV services uptake amongst gender diverse women and transfeminine women in South Africa. We recommend future studies to further explore the unique HIV risks of gender diverse individuals. Trial registration DOH-27-0513-4253.

scholarly journals Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

2021 ◽  
Vol 20 ◽  
pp. 232595822097811
Author(s):  
Lily Y. Gu ◽  
Nanhua Zhang ◽  
Kenneth H. Mayer ◽  
James M. McMahon ◽  
Soohyun Nam ◽  
...  
Keyword(s):  
Gender Nonconformity ◽  
Hiv Stigma ◽  
Hiv Care ◽  
Sex Behavior ◽  
Related Stigma ◽  
And Gender ◽  
Sex With Men ◽  
Linkage To Hiv Care ◽  
Living With Hiv ◽  
The Impact

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

scholarly journals An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana

2020 ◽  
Vol 24 (7) ◽  
pp. 2119-2129 ◽  
Author(s):  
Russell Brewer ◽  
Kristina B. Hood ◽  
Mary Moore ◽  
Andrew Spieldenner ◽  
Chris Daunis ◽  
...  
Keyword(s):  
Exploratory Study ◽  
Hiv Care ◽  
Related Stigma ◽  
Care Outcomes ◽  
Sex With Men ◽  
Living With Hiv

scholarly journals What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission?

2017 ◽  
Vol 94 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Keerthi Mohan ◽  
Matthew Hibbert ◽  
Graeme Rooney ◽  
Malcolm Canvin ◽  
Tristan Childs ◽  
...  
Keyword(s):  
Sexual Transmission ◽  
Undetectable Viral Load ◽  
Hiv And Aids ◽  
Sexual History ◽  
Hiv Status ◽  
Travel History ◽  
And Gender ◽  
Sex With Men ◽  
Living With Hiv

BackgroundEvidence suggests that sexual transmission between men has replaced foreign travel as the predominant mode of Shigella transmission in England. However, sexuality and HIV status are not routinely recorded for laboratory-reported Shigella, and the role of HIV in the Shigella epidemic is not well understood.MethodsThe Modular Open Laboratory Information System containing all Shigella cases reported to Public Health England (PHE) and the PHE HIV and AIDS Reporting System holding all adults living with diagnosed HIV in England were matched using a combination of Soundex code, date of birth and gender.ResultsFrom 2004 to 2015, 88 664 patients were living with HIV, and 10 269 Shigella cases were reported in England; 9% (873/10 269) of Shigella cases were diagnosed with HIV, of which 93% (815/873) were in men. Shigella cases without reported travel history were more likely to be living with HIV than those who had travelled (14% (751/5427) vs 3% (134/4854); p<0.01). From 2004 to 2015, the incidence of Shigella in men with HIV rose from 47/100 000 to 226/100 000 (p<0.01) peaking in 2014 at 265/100 000, but remained low in women throughout the study period (0–24/100 000). Among Shigella cases without travel and with HIV, 91% (657/720) were men who have sex with men (MSM). HIV preceded Shigella diagnosis in 86% (610/720), and 65% (237/362) had an undetectable viral load (<50 copies/mL).DiscussionWe observed a sustained increase in the national rate of shigellosis in MSM with HIV, who may experience more serious clinical disease. Sexual history, HIV status and STI risk might require sensitive investigation in men presenting with gastroenteritis.

scholarly journals Toward More Inclusive Gender Identity Measurement in Speech, Language, and Hearing Practice and Research

2020 ◽  
Vol 5 (6) ◽  
pp. 1710-1715
Author(s):  
Brandon Merritt
Keyword(s):  
Gender Identity ◽  
Communication Disorders ◽  
Demographic Information ◽  
Gender Nonconforming ◽  
Research Participants ◽  
Related Information ◽  
Gender Diverse ◽  
Gender Minorities ◽  
Optimal Health ◽  
And Gender

Purpose This article discusses current trends in clinical and research settings for collecting gender identity demographic information and argues for clinicians and researchers in communication disorders and sciences to adopt a two-question method for measuring the gender identity of clients and research participants. Traditional collection of gender demographic information has been constrained to a single question format with a binary response option. Increasing numbers of individuals across the life span identify with gender minorities such as transgender, nonbinary, and gender nonconforming, among others, and the traditional format for obtaining gender-identity related information is insufficient to capture and document this increasing diversity. An example of a two-question method for measuring gender identity demographic information is provided. The benefits and challenges of adopting such a measure in clinical and laboratory settings are discussed. Conclusions Gender minorities constitute a growing proportion of clinical caseloads and research participants within speech-language pathology and audiology. The adoption of demographic measurement tools that are inclusive of varying gender identities is necessary to acknowledge and quantify this growth and is a first step in normalizing transgender visibility in clinical and research settings. Such a move advances cultural responsiveness within the professions and promotes competent care and optimal health outcomes for individuals who are gender diverse.

scholarly journals Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing

Autism ◽  
2021 ◽  
pp. 136236132110421
Author(s):  
Goldie A McQuaid ◽  
Nancy Raitano Lee ◽  
Gregory L Wallace
Keyword(s):  
Autism Spectrum Disorder ◽  
Intellectual Disability ◽  
Gender Identity ◽  
Gender Diversity ◽  
Autistic Traits ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Gender Diverse ◽  
And Gender ◽  
Main Effects

Camouflaging in autism spectrum disorder could be a factor in later diagnosis of individuals without co-occurring intellectual disability, particularly among those designated female sex at birth. Little research to date has examined how gender identity impacts camouflaging, however. Further, no study has compared groups that differ in diagnostic timing to directly investigate if later-diagnosed individuals demonstrate elevated camouflaging relative to those receiving an earlier diagnosis. Using the Camouflaging Autistic Traits Questionnaire subscales (Assimilation, Compensation, and Masking), we investigated the roles of sex, gender identity (gender diverse vs cisgender), and diagnostic timing (childhood/adolescent-diagnosed vs adult-diagnosed), and the interactions of these factors, in autistic adults ( N = 502; age 18–49 years). Main effects of sex, gender identity, and diagnostic timing were revealed. Autistic females reported more camouflaging across Camouflaging Autistic Traits Questionnaire subscales compared to males. Gender diverse adults reported elevated camouflaging on the Compensation subscale compared to cisgender adults. Adulthood-diagnosed individuals reported elevated Assimilation and Compensation compared to childhood/adolescence-diagnosed individuals. We discuss how aspects of camouflaging may have particular implications for later diagnostic timing and for the intersection of neurodiversity and gender diversity. Lay abstract Camouflaging in autism spectrum disorder refers to behaviors and/or strategies that mask the presentation of autism spectrum disorder features in social contexts in order to appear “non-autistic” (Attwood, 2007). Camouflaging modifies the behavioral presentation of core autism spectrum disorder features (e.g. social and communication differences), but the underlying autistic profile is unaffected, yielding a mismatch between external observable features and the internal lived experience of autism. Camouflaging could be an important factor in later diagnosis of individuals without co-occurring intellectual disability, especially among those designated female sex at birth. Little research to date has examined how gender identity impacts camouflaging, however. Furthermore, no study has compared groups that differ in diagnostic timing to directly investigate if later-diagnosed individuals show elevated camouflaging relative to those receiving an earlier diagnosis. We used the Camouflaging Autistic Traits Questionnaire subscales (Assimilation, Compensation, and Masking) and investigated the roles of sex, gender identity (gender diverse vs cisgender), and diagnostic timing (childhood/adolescent-diagnosed vs adult-diagnosed), and the interactions of these factors, in autistic adults ( N = 502; ages 18–49 years). Main effects of sex, gender identity, and diagnostic timing were revealed. Autistic females reported more camouflaging across all three Camouflaging Autistic Traits Questionnaire subscales compared to males. Gender diverse adults reported elevated camouflaging on the Compensation subscale compared to cisgender adults. Adulthood-diagnosed individuals reported elevated Assimilation and Compensation compared to childhood/adolescence-diagnosed individuals. We discuss how the aspects of camouflaging may have unique implications for later diagnostic timing and for the intersection of neurodiversity and gender diversity.

scholarly journals Potential HIV transmission risk among spouses: marriage intention and expected extramarital male-to-male sex among single men who have sex with men in Hunan, China

2019 ◽  
Vol 96 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Weizi Wu ◽  
Xiaochen Yan ◽  
Xiaoxia Zhang ◽  
Lloyd Goldsamt ◽  
Yuanyuan Chi ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Multivariate Logistic Regression Analysis ◽  
Transmission Risk ◽  
Cross Sectional Survey ◽  
Sexual Behaviours ◽  
Route Of Transmission ◽  
Related Stigma ◽  
Male Sex ◽  
Sex With Men ◽  
Hiv Transmission Risk

ObjectiveThe HIV epidemic in China is shifting from the high-risk groups of men who have sex with men (MSM), injection drug users and sex workers to the general population, and sexual contact among spouses is assumed to be one route of transmission. Our objective was to determine the intention to marry and the expected extramarital male-to-male sex among single Chinese MSM, in order to estimate the potential HIV transmission risk among MSM living with HIV and their female spouses.MethodsWe conducted a web-based, cross-sectional survey between May 2016 and May 2017. A questionnaire covering sociodemographic characteristics, sexual behaviours, HIV-related and homosexuality-related stigma, marriage intention, and expected extramarital sexual behaviours was completed by 556 single MSM in Hunan, China. Descriptive statistics, χ2 test, two-sample t-test and multivariate logistic regression analysis were performed.ResultsCurrently 48.9% of the participants intended to marry a woman in their lifetime, and 91% of them reported that they would continue to have sex with men after getting married. Those who were living with parents (OR=2.26), self-identified as bisexual (OR=2.57), had at least one heterosexual partner in the previous 6 months (OR=0.33) and perceived a higher level of self-homosexual stigma (OR=1.78) had greater intention to marry a woman.ConclusionNearly half of Chinese MSM intend to marry women, which has significantly dropped from the estimated percentage more than 10 years ago for Chinese MSM. However, the expectation of extramarital homosexual behaviours was common in these men. Sexual and gender minority stresses especially from family members, homosexual identity assertiveness and related stigma were the main factors for marriage intention, which should be addressed in future studies and practices.

Black lesbian women in South Africa: Citizenship and the coloniality of power

2020 ◽  
Vol 30 (3) ◽  
pp. 324-342
Author(s):  
Angeline Stephens ◽  
Floretta Boonzaier
Keyword(s):  
South Africa ◽  
Gender And Sexuality ◽  
Lesbian Women ◽  
Social Psychological ◽  
Group Discussions ◽  
Gender Diverse ◽  
Marginalised Groups ◽  
Black Lesbian ◽  
And Gender ◽  
Social Psychological Perspective

Current conceptualisations of citizenship in South Africa are embedded in the egalitarian discourse of the Constitution, lauded for its recognition of historically marginalised groups, including sexually and gender diverse people. Within the paradox of progressive legal advancements and the legacy of colonialism and apartheid, we use a decolonial feminist lens to critically engage with the notion of citizenship for black lesbian women in contemporary South Africa. We adopt a social-psychological perspective of citizenship as an active practice, embedded within the dynamic intersections of historical, structural and discursive patterns of power-knowledge relations in everyday life. We draw from five focus group discussions that were part of a study that explored the intersections of identity, power and violence in the lives of black lesbian women in South Africa. Focusing on the enactments of citizenship in public spaces, we contend that black lesbian women’s lived experiences of citizenship point to the enduring manifestations of the coloniality of power, in which the centrality of race underpins the intersections of class, gender and sexuality. We conclude by arguing that current conceptualisations of full citizenship in contemporary South Africa require a reframing that recognises the coloniality of power and the heterogeneity of marginalised and invisibilised subjectivities.

Responding to narrowing discrimination protections: Can hospital policies protect transgender and gender diverse patients with cancer?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14126-e14126
Author(s):  
Ash Alpert ◽  
Elizabeth Stieglitz Tarras ◽  
Amani Sampson ◽  
Myla S. Strawderman ◽  
Megan Sutter ◽  
...  
Keyword(s):  
Gender Identity ◽  
Cancer Care ◽  
Sex Discrimination ◽  
Bill Of Rights ◽  
Local Policy ◽  
Cancer Centers ◽  
Department Of Health ◽  
Gender Diverse ◽  
Hospital Policies ◽  
And Gender

e14126 Background: The U.S. Department of Health and Human Services recently proposed to eliminate federal protections against discrimination in healthcare on the basis of gender identity. This proposal seeks to alter the Patient Protection and Affordable Care Act Section 1557 Rule, which currently prohibits sex discrimination in any health program receiving federal financial assistance. The provisional change poses imminent threats to transgender and gender diverse (TGD) communities who face discrimination in healthcare, and in cancer care specifically. If current federal protections are eliminated, enacting local non-discrimination policies may safeguard TGD individuals’ rights to access safe equitable cancer care. To determine the need for local policy change, we sought to assess the current protections based on gender identity and expression for patients at National Cancer Institute (NCI)-Designated Cancer Centers. Methods: Publicly available hospital non-discrimination policies and Patients’ Bill of Rights were examined from the main affiliated hospitals of each of the 62 NCI-Designated Cancer Centers, excluding laboratories. The policies were classified as clearly including gender identity and expression or not. McNemar’s Test calculated differences between non-discrimination policies and Patient’ Bill of Rights. Results: Of 62 institutions, 30 (48.4%) clearly included gender identity and expression in their hospital non-discrimination policies, whereas 45 (72.6%) included gender identity and expression in their Patients’ Bill of Rights ( p= 0.014). Thirty-seven (59.7%) institutions included gender identity and expression in only one of the documents (Table). Conclusions: NCI-Designated Cancer Centers do not consistently include gender identity and expression in publicly available non-discrimination documents. The discrepancy between Patients’ Bill of Rights documents and hospital non-discrimination policies suggests a difference between what institutions outwardly convey to patients and what they operationalize in their legal documents. Paired outcomes from 62 independent NCI-Designated Cancer Centers. [Table: see text]

Transgender and Gender Diverse (TGD) Asian Americans in the United States: Experiences of Violence, Discrimination, and Family Support

2021 ◽  
pp. 088626052110567
Author(s):  
Justin E. Lerner ◽  
Jane J. Lee
Keyword(s):  
United States ◽  
Gender Identity ◽  
Family Support ◽  
Asian Americans ◽  
The United States ◽  
Unequal Treatment ◽  
Physical Attack ◽  
Gender Diverse ◽  
And Gender ◽  
The U.S

Transgender and gender diverse (TGD) Asian Americans in the U.S. have multiple stigmatized identities, yet their experiences of violence and discrimination are not well understood. We utilized the 2015 United States Trans Survey, the largest survey to date with U.S. TGD people, to study the experiences of TGD Asian Americans. Our study included 699 TGD Asian Americans who experienced violence and discrimination in the form of unequal treatment, verbal harassment, and physical attack. We assessed how experiences differed by sociodemographic characteristics, including birthplace, income, age, education, disability, gender identity, and region. We also explored how family support was associated with experiences of violence in the sample. Bivariate analyses and multivariable regressions were used to understand how sociodemographic variables and family support are linked to experiences of violence and discrimination. Results indicated that income, age, disability, gender identity, and family support are significantly associated with violence and discrimination. As TGD Asian Americans currently experience high levels of violence and discrimination due to transphobia and a rapidly rising anti-Asian bias stemming from the COVID-19 pandemic, efforts to better understand factors that may increase vulnerability and identify how family support can mitigate those experiences are imperative.

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