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Background: Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, including in anogenital sexually transmitted infections (STI). Gender-affirming hormone therapy (GAHT) is known to be medically necessary and improve health. Few studies have assessed the effect of GAHT on STI diagnoses. Objective: To evaluate the effect of GAHT delivered in primary care as an intervention to improve STI outcomes for TGD adults. Design: LEGACY is a longitudinal, multisite cohort study of adult TGD primary care patients from two federally qualified community health centers in Boston, MA, and New York, NY. Participants: Electronic health record data for eligible adult TGD patients contributed to the LEGACY research data warehouse (RDW). A total of 6330 LEGACY RDW patients were followed from 2016 to 2019, with 2555 patients providing STI testing data. Main Measures: GAHT exposure was being prescribed hormones, and the clinical outcome was anogenital gonorrhea or chlamydia diagnoses. Log-Poisson generalized estimating equations assessed the effect of prescription GAHT on primary outcomes, adjusting for age, race, ethnicity, gender identity, poverty level, health insurance, clinical site, and cohort years. Key Results: The median age was 28 years (IQR = 13); the racial breakdown was 20.4% Black, 8.1% Multiracial, 6.9% Asian/Pacific Islander, 1.8% Other; 62.8% White; 21.3% Hispanic/Latinx; 47.0% were assigned female at birth, and 16.0% identified as nonbinary. 86.3% were prescribed hormones. Among those tested, the percentage of patients with a positive anogenital STI diagnosis ranged annually from 10.0 to 12.5% between 2016 and 2019. GAHT prescription was associated with a significant reduction in the risk of anogenital STI diagnosis (aRR = 0.75; 95% CI = 0.59–0.96) over follow-up. Conclusions: GAHT delivered in primary care was associated with less STI morbidity in this TGD cohort over follow-up. Patients may benefit from individualized and tailored clinical care alongside GAHT to optimize STI outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.Method: Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N = 28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.Results: Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) men, 3 (10.7%) women, 8 (28.6%) transgender men, 10 (35.7%) transgender women, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a 'cisgender lens", distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.Conclusion: Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them. [ABSTRACT FROM AUTHOR]

Young transgender women aged 16–29 years experience high rates of carceral involvement, warranting greater inclusion of this community within decarceration research and practice. The present study investigates patterns of violence, exclusion, resilience, and arrest among a sample of 298 transgender women aged 16–29 years in Chicago, Illinois, and Boston, MA. Women in the sample reported high rates of arrest, violence, and exclusion. Latent class analysis (LCA) was used to identify classes with similar response patterns to items assessing violence, exclusion, resilience, and arrest. A three-class model was selected to best represent the data, including: (a) "High Violence and Exclusion/High Arrest"; (b) "Low Arrest"; and (c) "Moderate Violence and Exclusion/High Arrest." Race and perceived gender expression significantly predicted class membership. Findings illustrate the heterogeneity of young transgender women's experiences, suggesting that a variety of tailored decarceration program and policy interventions are required to meet the differing needs of young transgender women. [ABSTRACT FROM AUTHOR]

Transmasculine people are at risk of cervical cancer but have lower rates of cervical cancer screening than cisgender women. Disaffirmation of the patient's gender and unequal power dynamics between patient and provider during screening contribute to patient unwillingness to be screened. The mechanisms by which the balance of power may be shifted between patient and provider, and by which gender is constructed during the Pap test, are not well understood. A qualitative study using a modified grounded theory approach was undertaken to analyse patient interview and provider interview and focus group data pertaining to power and gender in the context of cervical cancer screening among transmasculine individuals. The study was conducted at an LGBTQ-focussed health centre in Boston, USA. Processes by which power is enacted included constraining or affirming patient choice, mitigating or exacerbating vulnerability, and self-advocacy. Gendering processes included naming patients and their bodies, invoking gender norms, de-gendering/re-gendering Pap tests, and othering or normalising trans bodies. The interplay between these processes promotes or constrains patient agency over body and health, impacting patient care, patient-provider interaction, and service utilisation. Understanding patient and provider roles in power and gender dynamics are critical for the provision of patient-centred care. [ABSTRACT FROM AUTHOR]

This study assessed the ability of a modified respondent-driven sampling (RDS) method to recruit racial and ethnic minority men who have sex with men (MSM) at risk for HIV and other sexually transmitted infections (STIs). We used a modified RDS technique, a relatively new method of chain-referral sampling, to recruit 50 MSM in Greater Boston for a behavioral survey and interview. Traditional recruitment methods used by Fenway Community Health, a community-based health care and research facility, yield samples comprised of 15% to 30% racial/ethnic minority MSM. The present study recruited a sample of 60% racial/ethnic minority MSM, a significant difference from these earlier studies (all p values < .0001). Forty-five percent of the sample reported an annual income of less than $12,000, and 17% did not always have a regular place to live in the past year. Sixty-six percent of respondents were HIV infected; 43% reported a prior STI diagnosis. This study provides evidence that a modified RDS strategy can effectively engage at-risk racial/ethnic minority MSM, which has important implications for the enrollment of these populations in HIV prevention interventions and other social services. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) continue to bear a disproportionate HIV and sexually transmitted disease (STD) burden. The current study examined the frequency and associations of sexual risk reduction behaviors among a sample of MSM in the greater Boston, Massachusetts area. One hundred eighty-nine MSM completed a one-time behavioral and psychosocial assessment between March 2006 and May 2007. Logistic regression procedures examined the association of demographic, psychosocial, and behavioral factors with risk reduction practices. Twenty percent of the sample reported rimming, mutual masturbation, digital penetration, using sex toys, or 100% condom use as a means to reduce their risk of acquiring or transmitting HIV in the prior 12 months. In bivariate analyses, risk reducers were more likely to disclose their MSM status (i.e., be “out”; odds ratio [OR] = 3.64; p < 0.05), and report oral sex with a condom in the prior 12 months (OR = 4.85; p < 0.01). They were less likely to report: depression (Center for Epidemiologic Studies Depression Scale [CES-D] score 16+; OR = 0.48; p < 0.05), a history of one or more sexually transmitted diseases (STDs; OR = 0.40; p < 0.05), and meeting sexual partners at public cruising areas (OR = 0.32; p < 0.01). In a multivariable model, risk reducers were less likely to report: alcohol use during sex (adjusted odds ratio [AOR] = 0.33; p < 0.05), depression (CESD score 16+; AOR = 0.32; p < 0.05), or meeting sexual partners at public cruising areas (AOR = 0.30; p < 0.05), or via the Internet (AOR = 0.12; p < 0.05) in the previous 12 months. Identifying and understanding such factors associated with risk reduction behaviors may be important to consider in designing effective prevention interventions to promote sexual health for MSM. [ABSTRACT FROM AUTHOR]

Objectives. We assessed Boston-area men who have sex with men (MSM) in terms of their knowledge of partner notification (PN)/partner counseling and referral services (PCRS) and intentions to use such services if exposed to! infected with a sexually transmitted disease (STD) or human immunodeficiency virus (HIV) in the future. Methods. The study used a convenience sample of STD clinic patients (n=48) and a modified respondent-driven sampling method (n=70) to\reach a diverse sample of MSM (total sample n=118) in Massachusetts. Participants completed a one-on-one, open-ended, semistructured qualitative interview and quantitative survey. Results. Overall, white, HIV-infected MSM had the highest level of knowledge about PN activities. MSM who were unfamiliar with PN were disproportionately nonwhite and HIV-uninfected. Participants were more likely to notify past partners of HIV exposure than STD exposure. The preferred method of PN for the majority of MSM was direct person-to-person notification. Notably, nonwhite participants were more likely to endorse Massachusetts Department of Public Health PN services than white MSM, who preferred involvement of primary care providers. Conclusions. PN is an important public health strategy for treating and preventing STDs and HIV among at-risk populations, especially MSM who engage in sexual behavior with anonymous or otherwise non-notifiable sexual partners. Although many MSM had an understanding of the ethical desirability of informing exposed partners and recognized the value of preventative behaviors, they require further education to overcome barriers to PN as well as to gain knowledge of the various methods of both traditional and nontraditional notification, such as Internet PN. [ABSTRACT FROM AUTHOR]

The article presents a study regarding the positivity of sexually transmitted disease (STD) tests among men who have sex with men (MSM) at Fenway Community Health (FCH) in Boston, Massachusetts. It states that the prevalence of STD screenings for gonorrhea, chlamydia, and syphilis infection was examined in terms of HIV status, demographic characteristics, and reason for testing. Results show that gonorrhea and syphilis seropositivity are frequently diagnosed among asymptomatic MSM.

The article aims to determine the prevalence of asymptomatic sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Boston, Massachusetts who had been sexually active with another male within the past year. In doing so, the authors screen asymptomatic MSM in care at a Boston community health center for gonorrhea and chlamydia using the BD ProbeTec technique. They analyze deindentified medical record data and link to prevalence monitoring results. Discussion on the results of the study is provided. Moreover, the study concludes that screening these people showed a substantial STD burden that might not have been diagnosed using traditional assays.