Stigma and the Syndemic of Hiv‐related Health Risk Behaviors in a Diverse Sample of Transgender Women

Operario, Don; Yang, Mei‐Due; Reisner, Sari L.; Iwamoto, Mariko; Nemoto, Tooru

doi:10.1002/jcop.21636

Cited by 74 publications

(67 citation statements)

References 39 publications

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“…Our findings are consistent with recent research that found HIV-positive YBMSM frequently experience discriminatory treatment, ostracism, and unwanted status disclosure [51, 52]. Yet, despite its prevalence, few studies have examined stigma and its relationship to sexual, psychological, and clinical health outcomes among YBMSM across a single sample.…”

Section: Discussionsupporting

confidence: 91%

Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men

et al. 2016

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This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91–1.00 and OR 0.50, 95 % CI 0.25–1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20–3.94) and psychological distress (OR 5.02, 95 % CI 1.54–16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.

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Section: Discussionsupporting

confidence: 91%

Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men

et al. 2016

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“…Uncovering such treatment mechanisms would suggest the most promising psychosocial processes to target in future treatment approaches. Finally, examining the efficacy of ESTEEM as specifically adapted to other diverse sexual orientation groups, including lesbian and bisexual women and transgender individuals, seeking treatment in diverse settings (e.g., community clinics) and communities (e.g., rural), would extend the promise of this intervention to the full spectrum of sexuality and gender diversity affected by minority stress processes (Lehavot & Simoni, 2011; Operario, Yang, Reisner, Iwamoto, & Nemoto, 2014). …”

Section: Discussionmentioning

confidence: 99%

LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach.

Pachankis¹,

Hatzenbuehler²,

Rendina³

et al. 2015

Journal of Consulting and Clinical Psychology

470

396

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Objectives We tested the preliminary efficacy of a transdiagnostic cognitive behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. Method Young gay and bisexual men (n=63; M age=25.94) were randomized to immediate treatment or a three-month waitlist. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of past-90-day risk behavior. Results Compared to waitlist, treatment significantly reduced depressive symptoms (b=−2.43, 95% CI: −4.90, 0.35, p<0.001), alcohol use problems (b =−3.79, 95% CI: −5.94, −1.64, p<0.001), sexual compulsivity (b =−5.09, 95% CI: −8.78, −1.40, p<0.001), and past-90-day condomless sex with casual partners (b =−1.09, 95% CI: −1.80, −0.37, p<0.001), and improved condom use self-efficacy (b =10.08, 95% CI: 3.86, 16.30, p<0.001). The treatment yielded moderate and marginally significant greater improvements than waitlist in anxiety symptoms (b =−2.14, 95% CI: −4.61, 0.34, p=0.09) and past-90-day heavy drinking (b =−0.32, 95% CI: −0.71, 0.07, p=0.09). Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. Conclusion This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men’s co-occurring health problems at their source in minority stress. If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice. Public Health Significance Sexual orientation-related disparities in depression and anxiety co-occur with alcohol use, sexual compulsivity, and risky sexual behavior to form a syndemic health threat surrounding young gay and bisexual men. Clear and consistent evidence suggests that a major source of this syndemic is minority stress—the stress associated with stigma-related social disadvantage that compounds general life stress. This study represents the first test of an adapted cognitive behavioral intervention designed to alleviate minority stress among young gay and bisexual men to improve the co-occurring health conditions facing this population.

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“…22 Previous research has documented frequent risk behaviors such as unprotected sex, illicit drug use, and hazardous alcohol use in samples of transgender women, 4,11 and findings have shown that stigma is associated with each of these health risk behaviors. 30 Multiple factors associated with TRD have included: low socioeconomic status, racial/ethnic status, lacking health insurance, and a history of sexual and physical violence. 19 It is unclear whether exposure to stigma has an independent association with mental health indicators among transgender women, controlling for the presence of these additional health risk factors.…”

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confidence: 99%

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

et al. 2015

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Purpose: Previous research indicates elevated risk for psychological distress in sexual and gender minority populations, and some research suggests that stigma contributes to elevated psychological distress among members of these groups. This study examined the hypothesis that exposure to transgender-related stigma (TRS) is associated with both higher levels of depression and anxiety among transgender women. Methods: We analyzed data from a diverse sample of 191 adult transgender women living or working in the San Francisco Bay area who were recruited using purposive sampling methods to participate in a cross-sectional survey, which included measures of stigmatization, depression, and anxiety. Results: Higher levels of exposure to TRS were independently associated with higher levels of depression (b = 0.31, P < .001) and anxiety (b = 39, P < .001), adjusting for self-reported health and sociodemographic covariates. Associations between stigmatization, depression, and anxiety were not moderated by participants' age or race/ethnicity. Conclusion: Findings suggest a need for counseling interventions to address the role of stigmatization as a factor potentially contributing to psychological distress among transgender women. This research further highlights the need to develop a stronger evidence base on effective counseling approaches to improve the mental health of transgender women.

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Stigma and the Syndemic of Hiv‐related Health Risk Behaviors in a Diverse Sample of Transgender Women

Cited by 74 publications

References 39 publications

Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men

Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men

LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach.

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

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