Search

Due to multiple minority statuses, transgender women of color are exposed to minority stress through distal (external) stressors from society causing proximal (internal) stress, leading to potentially negative physical and mental health outcomes. Often considered allies to the transgender community, cisgender members of the LGBTQIA+ “community” have historically presented different plights resulting in divergent rights, protections, and societal views. Guided by the minority stress framework, a secondary analysis of individual interviews and focus groups (n = 20) with transgender women of color was performed. Participants shared experiences of distal and proximal minority stressors when discussing the cisgender LGBTQIA+ “community” and mitigating resilience factors. Four main themes emerged: 1) preference for cisgender presentation; 2) discrimination and exclusion; 3) mistrust; and 4) resilience. This is the first study to demonstrate direct mental and physical health risks for transgender women of color associated with discrimination and exclusion by members of the cisgender LGBTQIA+ “community.” Negative experiences resulted in health care avoidance, verbal assault, social exclusion, mistrust of providers, and barriers to transgender-affirming care. Future research must consider minority stress to advance the understanding of LGBTQIA+ within-group marginalization and foster equitable opportunities for transgender women of color and other gender minorities. [ABSTRACT FROM AUTHOR]

Characterization of HIV risk factors among transwomen and men who have sex with men (MSM) should be assessed separately and independently. However, due to several constraints, these populations continue to be conflated in clinical research and data. There are limited datasets globally powered to make such comparisons. The study aimed to use one of the largest surveys of transwomen and MSM in Latin America to determine differences in HIV risk and related correlates between the two populations. Secondary data analysis was completed using a cross-sectional biobehavioral survey of 4413 MSM and 714 transwomen living in Perú. Chi Square analysis of selected HIV correlates was conducted to examine differences between transwomen and MSM. Additionally, stratified binary logistic regression was used to split data for further comparative analyses of correlates associated with transwomen and MSM separately. HIV prevalence among transwomen was two-fold greater than among MSM (14.9% vs. 7.0%, p<0.001). Transwomen had a higher prevalence of most HIV risk factors assessed, including presence of alcohol dependence (16.4% vs. 19.0%; p < .001) and drug use in the past 3 months (17.0% vs. 14.9%). MSM were more likely to use marijuana (68.0% vs. 50.0%, p < .001), and transwomen were more likely to engage in inhaled cocaine use (70.0% vs. 51.1%, p < .001). The regression exposed differences in correlates driving sub-epidemics in transwomen vs. MSM, with a trend of substance use increasing HIV risk for transwomen only. Transwomen were more likely to be HIV-infected and had different risk factors from MSM. Targeted prevention strategies are needed for transwomen that are at highest risk. Additionally, further research is needed to determine if these observations in Perú regarding substance use patterns and the role of substance use in HIV risk relate to other trans populations globally., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cyrus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Despite being largely preventable, HPV-related cervical cancers continues to be the second highest cause of cancer deaths among Indian women. HPV testing using self-sampled samples may offer an opportunity to expand cervical cancer screening in India where there is currently a shortage of providers and facilities for cervical cancer screening. The study examines acceptability and concordance of self vs. clinician collected samples for HPV-relted cervical cancer screening among rural South Indian women., Methods: Between May and August 2017, eight mobile screening clinics were conducted among 120 eligible women in rural villages in Mysore District, India. Women over the age of 30 underwent informed consent process and then self-sampled a sample for cervicovaginal HPV DNA testing. Next, the women underwent clinical exam where the clinician collected a cervicovaginal HPV DNA sample. Following the clinical exam, all participants answered an interviewer-administered questionnaire to assess their history of cervical cancer screening and acceptability of self- and clinician-sampling methods. To assess diagnostic accuracy, concordance of self- and clinician-sampled HPV DNA specimens was calculated in addition to five measures of acceptability (feeling of caring, privacy, embarrassment, genital discomfort, and genital pain)., Results: Study participants had a median age 39 years, about four-in-ten (41.7%) had a secondary education or above, the vast majority (87.5%) were married and only 3.4% reported having screened for cervical cancer. For all measures of participant acceptability, self-sampling was rated significantly higher than clinician-sampling. Cohen's kappa was 0.73 (95% CI: 0.34, 1.00), indicating substantial agreement between self- and clinician-sampling., Conclusion: This study demonstrates that HPV self-sampling for cervical cancer screening is feasible and acceptable in a community setting among South Indian rural women. Concordance between self-sampling and clinician-sampling was adequate for screening in community settings.  , .

Purpose: The purpose of this ecological study was to understand the impact of the density of African American (AA) communities on coronavirus disease 2019 (COVID-19) prevalence and death rate within the three most populous counties in each U.S. state and territory ( n =152). Methods: An ecological design was employed for the study. The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n =152 counties. Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. Linear regression was used to determine the association between AA density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. Results: There was a direct association between AA density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density ( p <0.01). There was also an association between county AA density and COVID-19 deaths; the death rate increased 2 per 100,000 for every percentage increase in county AA density ( p =0.02). Conclusion: These findings indicate that communities with a high AA density have been disproportionately burdened with COVID-19. To help develop effective interventions and programs that address this disparity, further study is needed to understand social determinants of health driving inequities for this community., Competing Interests: No competing financial interests exist., (© Elena Cyrus et al. 2020; Published by Mary Ann Liebert, Inc.)

Background: Among men who have sex with men, pre-exposure prophylaxis (PrEP) reduces the risk of HIV by 95%. Based on the documented benefits, the Centre for Disease Control and Prevention has recommended PrEP as a prevention method for high-risk groups. Moreover, for those HIV-infected individuals, antiretroviral therapy has been shown to serve as both as a treatment and prevention method for HIV., Methods and Analysis: This systematic review protocol was reported according to the Preferred Reporting Items for Systematic reviews and Analyses (PRISMA) P framework. Medline (1980-present), Embase (1980-present), CINAHL (1980-present), Cochrane Central Register of Controlled Trials and clinicaltrials.gov will be used to identify relevant articles based on a piloted search strategy. Peer-reviewed observational and experimental studies will be included. A narrative style will be used to describe descriptive data. A meta-analysis will be conducted if heterogeneity is not significant., Ethics and Dissemination: Recent evidence suggests that there is an increased risk of sexually transmitted infections (STIs) among high-risk persons that use PrEP. Furthermore, there is a paucity of data on the relationship of treatment as prevention and incidence of STIs. The findings of this review will assess this emerging public health phenomenon and serve to inform future public health policy. No formal ethical review is required for this protocol. All findings will be published in a peer reviewed journal., Protocol Registration Number: CRD42019128720., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study assessed the effect of stavudine (d4T) 30 mg dosage on lipoatrophy in HIV-infected patients on antiretroviral treatment., Methods: A total of 243 patients from Cameroon receiving d4T or zidovudine (AZT) in combination with lamivudine and efavirenz or nevirapine for >6 months were clinically assessed for moderate to severe ('strict' definition) and mild to severe ('large' definition) lipoatrophy. Prevalence of lipoatrophy was compared between 69 patients who had received exclusively d4T 30 mg (d4T(30)), 64 patients who had received both d4T 30 and 40 mg dosages since treatment initiation (d4T(30/40)) and 110 patients on AZT-related therapy., Results: Prevalence of lipoatrophy varied from 7% to 24%, according to the definition. After adjustment for gender, age, treatment duration and CD4(+) T-cell count, the risk of lipoatrophy in the d4T(30) group was lower than in the d4T(30/40) group (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.8 with the large definition and OR 0.2, 95% CI 0.0-0.8 with the strict definition) and was comparable to that of the AZT group (OR 1.0, 95% CI 0.2-4.6 and OR 1.0, 95% CI 0.4-2.2 with the large and strict definitions, respectively). The risk was significantly higher in the d4T(30/40) group compared with the AZT group (OR 2.9, 95% CI 1.3-6.4 with the large definition and OR 5.5, 95% CI 1.3-23.5 with the strict definition)., Conclusions: The use of d4T at a lower dosage might increase safety with regard to its effect on lipoatrophy.

Outpatient surgery requires different criteria: short duration, non painful and non hemorrhagic postoperative follow up, a trained surgical and anesthesiological team. Many common ophthalmological surgical procedures meet these criteria. For a safe outpatient surgery, one must be careful for the patient selection and for the quality of the anesthesiology and the surgery. Outpatient surgery is common in other countries. In France, various centers are developing this approach. Many factors may explain why it seems easier to organize outpatient surgery in the private practice than in the public Hospital.