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Journal of the International AIDS... Apr 2024We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore...
Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe.
INTRODUCTION
We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation.
METHODS
A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation.
RESULTS
Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20-26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05).
CONCLUSIONS
Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.
Topics: Infant, Newborn; Male; Female; Humans; Young Adult; Adult; Homosexuality, Male; Transgender Persons; HIV Infections; Zimbabwe; Sexual and Gender Minorities; Sexual Behavior; Gender Identity; Surveys and Questionnaires
PubMed: 38627887
DOI: 10.1002/jia2.26231 -
International Journal For Equity in... Apr 2024Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address...
BACKGROUND
Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address challenges posed by the disease. These strategies aim to improve the care, support, and resources available to meet the needs of persons living with dementia and their care partners and communities. Despite the known impact of social determinants of health on dementia risk, care, and outcomes, it is unclear whether dementia strategies adequately address related inequities. This study aimed to describe whether and how national dementia strategies considered inequities associated with social determinants of health.
METHODS
We conducted an environmental scan of the national dementia strategies of countries that are part of the Organisation for Economic Cooperation and Development (OECD). Included strategies had to be accessible in English or French. Sub-national or provincial plans were excluded. We synthesised information on strategies' considerations of inequity through a thematic analysis.
RESULTS
Of the 15 dementia strategies that met inclusion criteria, 13 mentioned at least one inequity (M = 2.4, median = 2, range:0-7) related to Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Age and disability were mentioned most frequently, and religion most infrequently. Eleven strategies included general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage changes, deadlines, or allocated budgets for achieving equity-related goals outlined in their strategies.
CONCLUSIONS
Understanding if and how countries consider inequities in their dementia strategies enables the development of future strategies that adequately target inequities of concern. While most of the strategies mentioned inequities, few included tangible objectives to reduce them. Countries must not only consider inequities at a surface-level; rather, they must put forth actionable objectives that intend to lessen the impact of inequities in the care of all persons living with dementia.
Topics: Humans; Female; Male; Gender Identity; Social Class; Ethnicity; Disabled Persons; Dementia
PubMed: 38627768
DOI: 10.1186/s12939-024-02166-8 -
Journal of Physical Activity & Health Jul 2024LGBTQ+ youth engage in organized physical activity to a lesser degree than their cisgender and heterosexual counterparts. Existing literature on this organized physical...
BACKGROUND
LGBTQ+ youth engage in organized physical activity to a lesser degree than their cisgender and heterosexual counterparts. Existing literature on this organized physical activity disparity is limited, particularly with LGBTQ+ youth samples. The current analysis examined individual and systemic barriers to organized physical activity for LGBTQ+ youth across sexual, gender, and racial identities.
METHODS
A subsample of LGBTQ+ students (N = 4566) from the 2021 Dane County Youth Assessment completed items that measured barriers to organized physical activity and systemic factors (ie, family money problems and bias-based bullying) associated with access to organized physical activity. Latent class analysis discerned patterns of individual and systemic barriers to organized physical activity. Latent class regression modeling tested gender, sexual, and racial identities as correlates of latent class membership.
RESULTS
More than half of the sample did not participate in organized physical activity. Four profiles of LGBTQ+ youth were discerned based on self-reported barriers: high barrier (8%), bullied (16%), low interest or perceived skills (28%), and low barrier (48%). The low-barrier class included a greater proportion of LGBTQ+ youth who identified as White, or cisgender, or heterosexual as well as youth self-reporting higher organized physical activity. The high-barrier and bullied classes comprised more marginalized gender and sexual identities.
CONCLUSIONS
LGBTQ+ youth experience individual and systemic barriers to organized physical activity, including inequitable access and bullying, and barriers are uniquely experienced across sexual, gender, and racial identities. Physical activity promotion among LGBTQ+ youth would be strengthened by policies that address inequitable access to opportunities and bias-based bullying.
Topics: Humans; Male; Sexual and Gender Minorities; Female; Adolescent; Exercise; Bullying; Gender Identity; Sex Factors; Racial Groups
PubMed: 38626889
DOI: 10.1123/jpah.2023-0652 -
PloS One 2024Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global...
BACKGROUND
Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV.
METHODS
We explored adult men's perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework.
RESULTS
Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence.
CONCLUSION
Interventions aimed at reducing IPV should consider the cultural and social impact on men's use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women.
Topics: Adult; Humans; Male; Female; Child; South Africa; Men; Intimate Partner Violence; Violence; Gender Identity; Risk Factors
PubMed: 38626034
DOI: 10.1371/journal.pone.0298198 -
Scientific Reports Apr 2024Work shows that sexually-diverse individuals face high rates of early life adversity and in turn increased engagement in behavioral outcomes traditionally associated...
Work shows that sexually-diverse individuals face high rates of early life adversity and in turn increased engagement in behavioral outcomes traditionally associated with adversity, such as sexual risk taking. Recent theoretical work suggests that these associations may be attributable to heightened sexual reward sensitivity among adversity-exposed women. We aimed to test these claims using a combination of self-report and EEG measures to test the relationship between early adversity, sexual reward sensitivity (both self-reported and EEG measured) and sexual risk taking in a sexually diverse sample of cis-gender women (N = 208) (Mage = 27.17, SD = 6.36). Results showed that childhood SES predicted self-reported sexual reward sensitivity which in turn predicted numbers of male and female sexual partners. In contrast we found that perceived childhood unpredictability predicted neurobiological sexual reward sensitivity as measured by EEG which in turn predicted male sexual partner number. The results presented here provide support for the notion that heightened sexual reward sensitivity may be a pathway through which early life adversity augments future sexual behavior, and underscores the importance of including greater attention to the dynamics of pleasure and reward in sexual health promotion.
Topics: Humans; Male; Female; Child; Self Report; Sexual Behavior; Sexual Partners; Gender Identity; Reward
PubMed: 38622142
DOI: 10.1038/s41598-024-58389-w -
Psychological Science May 2024Recently, gender-ambiguous (nonbinary) voices have been added to voice assistants to combat gender stereotypes and foster inclusion. However, if people react negatively...
Recently, gender-ambiguous (nonbinary) voices have been added to voice assistants to combat gender stereotypes and foster inclusion. However, if people react negatively to such voices, these laudable efforts may be counterproductive. In five preregistered studies ( = 3,684 adult participants) we found that people do react negatively, rating products described by narrators with gender-ambiguous voices less favorably than when they are described by clearly male or female narrators. The voices create a feeling of unease, or , that affects evaluations of the products being described. These effects are best explained by low familiarity with voices that sound ambiguous. Thus, initial negative reactions can be overcome with more exposure.
Topics: Humans; Female; Male; Adult; Young Adult; Voice; Stereotyping; Social Perception; Gender Identity; Adolescent; Middle Aged
PubMed: 38620057
DOI: 10.1177/09567976241238222 -
Chronobiology International May 2024Chronotype, an individual's preferred sleep-wake timing, is influenced by sex and age. Men sometimes report a later chronotype than women and older age is associated...
Chronotype, an individual's preferred sleep-wake timing, is influenced by sex and age. Men sometimes report a later chronotype than women and older age is associated with earlier chronotype. The sex-related changes in chronotype coincide with puberty and menopause. However, the effects of sex hormones on human chronotype remain unclear. To examine the impact of 3 months of gender-affirming hormone therapy (GAHT) on chronotype in transgender persons, this study used data from 93 participants from the prospective RESTED cohort, including 49 transmasculine (TM) participants starting testosterone and 44 transfeminine (TF) participants starting estrogens and antiandrogens. Midpoint of sleep and sleep duration were measured using the ultra-short Munich ChronoType Questionnaire (µMCTQ). After 3 months of GAHT, TM participants' midpoint of sleep increased by 24 minutes (95% CI: 3 to 45), whereas TF participants' midpoint of sleep decreased by 21 minutes (95% CI: -38 to -4). Total sleep duration did not change significantly in either group. This study provides the first prospective assessment of sex hormone use and chronotype in transgender persons, showing that GAHT can change chronotype in line with cisgender sex differences. These findings provide a basis for future studies on biological mechanisms and clinical consequences of chronotype changes.
Topics: Humans; Male; Transgender Persons; Female; Circadian Rhythm; Prospective Studies; Sleep; Adult; Gonadal Steroid Hormones; Surveys and Questionnaires; Young Adult; Testosterone; Middle Aged; Time Factors; Transsexualism; Chronotype
PubMed: 38616311
DOI: 10.1080/07420528.2024.2339989 -
Social Science & Medicine (1982) May 2024Gender diverse patients (including gender diverse, transgender, and non-binary people) deserve quality health care, which has been referred to as gender affirming care....
Gender diverse patients (including gender diverse, transgender, and non-binary people) deserve quality health care, which has been referred to as gender affirming care. Given that practitioners' attitudes and competence can influence their provision of gender affirming care, this study used a lens of transnormativity (Bradford & Syed, 2019; Johnson, 2016) to develop a measure of practitioners' transnormative beliefs. The aim of the study was to determine if these beliefs were related to practitioners' gender affirming attitudes and perceptions of competence in gender affirming practice. Survey data were collected from Australian medical and allied health practitioners (N = 95). Exploratory factor analysis was applied to items measuring transnormative beliefs, with the results supporting three higher order factors; conditional approval, narrative, and gender role beliefs. Conditional approval reflected belief in gender diverse identity as authentic and worthy of intervention. Narrative beliefs reflected understanding of common developmental experiences among gender diverse populations, specifically experiences of victimisation and nascence. Gender role beliefs reflected belief in the existence of gender roles. In models that regressed gender affirming attitudes and self-perceived competency on all transnormative beliefs, controlling for demographics and work history, practitioners higher in conditional approval were lower in gender affirming attitudes and practitioners higher in narrative beliefs were higher in gender affirming attitudes and competency. Conditional approval was not significantly associated with competency, and gender role beliefs were not significantly associated with attitudes or competency. Results indicate that practitioners' transnormative beliefs are related to their gender affirming attitudes and suggest that targeting these beliefs through training opportunities could bridge the gap between gender diverse people's healthcare needs and the ability of healthcare practitioners to provide high quality care.
Topics: Humans; Male; Female; Attitude of Health Personnel; Australia; Adult; Transgender Persons; Surveys and Questionnaires; Middle Aged; Allied Health Personnel; Gender Identity; Health Personnel; Gender-Affirming Care
PubMed: 38615615
DOI: 10.1016/j.socscimed.2024.116876 -
Acta Psychologica Jun 2024Languages can express grammatical gender through different ortho-phonological regularities present in nouns (e.g., the cues "-o" and "-a" for the masculine and the...
Languages can express grammatical gender through different ortho-phonological regularities present in nouns (e.g., the cues "-o" and "-a" for the masculine and the feminine respectively in Italian, Portuguese, or Spanish). The term "gender transparency" was coined to describe these regularities (Bates et al., 1995). In gendered languages, we can hence distinguish between transparent nouns, i.e., those displaying form regularities; opaque nouns, i.e., those with ambiguous endings; and irregular nouns, i.e., those that display the typical form regularities but are associated with the opposite gender. Following a descriptive analysis of such regularities, languages have been recently classified according to their degree of gender transparency, which seems relevant in regard to gender acquisition and processing. Yet, there are certain inconsistencies in determining which languages are overall transparent and which are opaque. In particular, it is not clear whether some other complex regularities such as derivational suffixes are also "transparent" cues for gender, what really constitutes an "opaque" noun, or which role orthography and morphology have in transparency. Given the existing inconsistencies in classifying languages as transparent or opaque, this work introduces a proposal to assess gender transparency systematically. Our methodology adapts the standardized factors proposed by Audring (2019) to analyse the relative complexity of gender systems. Such factors are adapted to gender transparency on the basis of the literature on gender acquisition and processing. To support the feasibility of such a proposal, the concepts have been instantiated in a quantitative model to obtain for the first time an objective measure of gender transparency using European Portuguese and Dutch as instances of target languages. Our results coincide with the theoretically expected outcome: European Portuguese obtains a high value of gender transparency while Dutch obtains a moderately low one. Future adaptations of this model to the gender systems of other languages could allow the continuum of gender transparency to sustain robust predictions in studies on gender processing and acquisition.
Topics: Humans; Language; Psycholinguistics; Female; Male; Gender Identity; Cues
PubMed: 38613854
DOI: 10.1016/j.actpsy.2024.104236 -
Reproductive Health Apr 2024Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most... (Review)
Review
BACKGROUND
Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC.
METHODS
Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs.
FINDINGS
The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels.
CONCLUSIONS
This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
Topics: Female; Pregnancy; Humans; Developing Countries; Refugees; Sexual Health; Reproductive Health; HIV Infections; Sexually Transmitted Diseases
PubMed: 38609975
DOI: 10.1186/s12978-024-01780-7