Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16–24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N=216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95% CI, 1.4–5.0), depression (AOR, 2.6; 95% CI, 1.2–5.9), and stress related to suicidal thoughts (AOR 7.7, 95% CI 2.3–35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95% CI 1.2–10.8), PTSD (AOR 2.1; 95% CI 1.1–4.2) and stress related to suicidal thoughts (AOR 4.3, 95% CI 1.5–13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.
Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems-binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse-comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.
Low access to HIV care and support has led to survival rates for transwomen that are half that of other populations at risk for HIV. Within the population, HIV disproportionately impacts African American transwomen. Interventions to increase access to HIV care and support are needed to better serve those most affected and vulnerable within the population. We conducted a study of barriers and facilitators to care and support services for African American transwomen to fill a gap in the literature to improve access for this particularly impacted population. A total of 10 in-depth interviews were conducted with African American transwomen living with HIV who lived outside the metro area of San Francisco. Three overarching thematic topics emerged-gender stigma, peer, and institutional distrust - giving insight into African American transwomen's barriers to HIV care and support services. A number of factors within these themes impacted access, such as whether organizations offered gender-related care, the geography of organizations as it relates to safe transportation and location, confidentiality and trust of peers and organizations, and trauma. Specific instrumental, institutional and emotional supports are provided that that may increase access to care and support services for African American transwomen living with HIV.
Introduction One of the biggest threats to the health of trans*females is HIV, particularly for those who are part of racial/minority groups. Yet health disparities for racial/ethnic minority trans*female youth remain understudied. Methods We examined baseline data from 282 trans*female youth ages 16–24 years old in the San Francisco Bay Area. We conducted Chi-squared tests for distributional differences between racial/ethnic minority and white participants in socio-demographic factors, HIV-related risk behaviors and syndemic factors. Results A total of 4.8% of trans*female youth were HIV positive. Racial/ethnic minority and white trans*female youth differed significantly in their gender identities and sexual orientations. Racial/minority youth also had significantly lower educational attainment, were less likely to live with their parents of origin as a child, and were significantly more likely to engage in recent condomless anal intercourse compared to whites. Conclusions Important disparities in HIV-related sexual risk behavior, education, and residential stability exist between racial/ethnic minority and white trans*female youth. Efforts to assess the impact of multiple minority stress for racial/minority trans*female youth are imminently needed. Additionally, macro-level disparities must be addressed in prevention efforts for trans*female youth, especially for those from racial/ethnic minority groups, in order to prevent incident cases of HIV and reduce disparities.
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