Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication

Background Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use. Methods This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues. Results Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP’s effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication. Conclusions Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.

Risk of gallstones based on ABCG8 rs11887534 single nucleotide polymorphism among Taiwanese men and women

Background Gallstones are abnormal masses caused by impaired metabolism of cholesterol, bilirubin, or bile salts in the gallbladder or biliary tract. ATP-binding cassette subfamily G member 8 (ABCG8) is a protein that regulates cholesterol efflux from the liver. Genome-wide association studies (GWAS) and meta-analyses of GWAS revealed the ABCG8 rs11887534 variant as the most common genetic determinant of gallstones in humans. These findings have not been extensively replicated in Taiwanese. Therefore, we appraised the relationship between gallstones and rs11887534 in a relatively large Taiwanese sample. Methods We retrieved data collected through questionnaires, physical and biochemical tests from the Taiwan Biobank Bank (TWB). The study participants comprised 7388 men and 13,880 women who voluntarily enrolled in the Taiwan Biobank project between 2008 and 2019. Gallstones were self-reported. Results The overall sample size was 21,268 comprising 938 gallstone patients and 20,330 non-gallstone individuals. Among the participants, 20,640 had the GG and 628 had the GC + CC genotype. At p-value < 0.05, the baseline genotypes and gallstone status between men and women were not significantly different. The risk of gallstones was higher in participants having the GC + CC compared to the GG genotype: odds ratio (OR); 95% confidence interval (CI) = 1.698; 1.240–2.325), but was lower in men compared to women (OR = 0.763; 95% CI = 0.638–0.913). Compared to men with the rs11887534 GG genotype, women with the GG and GC + CC genotypes had a higher risk of gallstone (OR; 95% CI = 1.304; 1.087–1.565 for GG and 2.291; 1.514–3.467 for GC + CC). The positive association between GC + CC and gallstones was retained after we restricted the analysis to the female participants (OR; 95% CI = 1.789 = 1.208–2.648). Hormone use was associated with an elevated risk of gallstones (OR; 95% CI = 1.359; 1.107–1.668). Relative to GG and no hormone use, we found a significantly high risk among hormone users with the GC + CC genotype (OR; 95% CI = 3.596; 1.495–8.650). Conclusions The rs11887534 GC + CC genotype was independently associated with a higher risk of gallstones. This risk was much higher among women, especially those who used hormones for various gynecological purposes.

Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data from the STRONG Cohort

Background Risk of type 2 diabetes mellitus (T2DM) in transgender and gender diverse (TGD) persons, especially those receiving gender affirming hormone therapy (GAHT) is an area of clinical and research importance. Methods We used data from an electronic health record-based cohort study of persons 18 years and older enrolled in three integrated health care systems. The cohort included 2869 transfeminine members matched to 28,300 cisgender women and 28,258 cisgender men on age, race/ethnicity, calendar year, and site, and 2133 transmasculine members matched to 20,997 cisgender women and 20,964 cisgender men. Cohort ascertainment spanned 9 years from 2006 through 2014 and follow up extended through 2016. Data on T2DM incidence and prevalence were analyzed using Cox proportional hazards and logistic regression models, respectively. All analyses controlled for body mass index. Results Both prevalent and incident T2DM was more common in the transfeminine cohort relative to cisgender female referents with odds ratio and hazard ratio (95% confidence interval) estimates of 1.3 (1.1-1.5) and 1.4 (1.1-1.8), respectively. No significant differences in prevalence or incidence of T2DM were observed across the remaining comparison groups, both overall and in TGD persons with evidence of GAHT receipt. Conclusion Although transfeminine people may be at higher risk for T2DM compared to cisgender females the corresponding difference relative to cisgender males is not discernable. Moreover, there is little evidence that T2DM occurrence in either transfeminine or transmasculine persons is attributable to GAHT use.

Associations of systemic health and medication use with the enlargement rate of geographic atrophy in age-related macular degeneration

BackgroundThe associations of geographic atrophy (GA) progression with systemic health status and medication use are unclear.MethodsWe manually delineated GA in 318 eyes in the Age-Related Eye Disease Study. We calculated GA perimeter-adjusted growth rate as the ratio between GA area growth rate and mean GA perimeter between the first and last visit for each eye (mean follow-up=5.3 years). Patients’ history of systemic health and medications was collected through questionnaires administered at study enrolment. We evaluated the associations between GA perimeter-adjusted growth rate and 27 systemic health factors using univariable and multivariable linear mixed-effects regression models.ResultsIn the univariable model, GA perimeter-adjusted growth rate was associated with GA in the fellow eye at any visit (p=0.002), hypertension history (p=0.03), cholesterol-lowering medication use (p<0.001), beta-blocker use (p=0.02), diuretic use (p<0.001) and thyroid hormone use (p=0.03). Among the six factors, GA in the fellow eye at any visit (p=0.008), cholesterol-lowering medication use (p=0.002), and diuretic use (p<0.001) were independently associated with higher GA perimeter-adjusted growth rate in the multivariable model. GA perimeter-adjusted growth rate was 51.1% higher in patients with versus without cholesterol-lowering medication use history and was 37.8% higher in patients with versus without diuretic use history.ConclusionsGA growth rate may be associated with the fellow eye status, cholesterol-lowering medication use, and diuretic use. These possible associations do not infer causal relationships, and future prospective studies are required to investigate the relationships further.

Overweight and Obesity Among Adults Identifying on the Transgender Spectrum in Newark, NJ Between 2018 and 2020: A Retrospective Chart Review

Objectives To assess levels of overweight and obesity among transgender adults receiving care in an academic medical center in Newark, NJ between 2018 and 2020. Methods We performed a retrospective review of electronic medical records of transgender adults (≥18 years) receiving care in an academic medical center in Newark, NJ from 2018 through 2020. We used CDC Body Mass Index (BMI) cut-offs to determine overweight or obesity. Results Of the 159 patients included in this study, the median age was 28 years (range 18–75 years), 47.8% were Black, 27.4% were LatinX and 24.8% were White. Majority (89.3%) were receiving gender-affirming hormones and 69.2% identified as transfeminine. One-third (34.6%) were current smokers, 35.2% had a diagnosis of depression and/or anxiety and 23.3% were living with HIV. BMI was not associated with gender identity, race, hormone use, smoking, HIV status, depression and/or anxiety. A higher proportion of transfeminine participants (31.8%) were HIV positive compared to 4.1% of those identifying as transmasculine. Median BMI of the sample was 26kg/m2, 26.4% were overweight and 32.7% obese. Of the 32.7% who were obese, 12.6% were classified as obesity class 1, 10.7% as obesity class 2, and 9.4% as obesity class 3. Conclusions In this retrospective chart review, almost 60% of all transgender adults were either overweight or obese. Future research is needed to further explore potential clinical implications of elevated weight, as well as the medical, social, psychological, and health behavior factors associated with overweight and obesity among transgender individuals. Funding Sources None.