Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

Using Intergroup Contact Theory to Reduce Stigma Against Transgender Individuals: Impact of a Transgender Speaker Panel Presentation

Sexual minorities experience significant stigma and prejudice. Much research has examined sexual stigma and prejudice impacting gay and lesbian individuals, but limited research has examined other sexual minorities, such as transgender persons or individuals whose gender identity or expression is incongruent with their assigned gender or anatomical sex. Research has found that interpersonal contact with sexual minorities is associated with lower sexual stigma and prejudice. Intergroup contact theory predicts that interaction between groups can reduce stereotyping and improve intergroup relationships. Using a randomized crossover design, this study compared the impact of exposure to a transgender speaker panel vs. a traditional transgender lecture presentation on transphobia. Results indicated greater immediate reductions of transphobia following the transgender speaker panel than traditional lecture.     

An Argument for Separate Analyses of Attitudes Toward Lesbian, Gay, Bisexual Men, Bisexual Women, MtF and FtM Transgender Individuals

While past research has certainly investigated a variety of correlates of U.S. attitudes toward lesbians, gays, bisexual men, bisexual women, male-to-female (MtF) and female-to-male (FtM) transgender (LGBT) individuals, there are no U.S. quantitative studies that could be located that examined attitudes toward each of these groups separately. This is especially important because efforts to combat prejudices are likely to be most successful if they are based in research that explores how attitudes are both similar and different across specified targets of prejudice. Toward that goal, this essay underscores the significance of examining U.S. attitudes toward LGBT individuals as separate constructs. Both the gender and sexual orientation of the target of prejudice and the gender and sexual orientation of the respondent are highlighted as important constructs that should be considered when investigating U.S. attitudes toward LGBT individuals. First, I review previous U.S. studies that have examined attitudes toward LGBT individuals. Second, I offer arguments for how the intersections of gender and sexual orientation may affect attitudes toward LGBT individuals. Third, I discuss future considerations in studies of attitudes toward LGBT individuals in the context of multiple intersectionalities. I suggest that U.S. initiatives to reduce sexual stigma, gender nonconformity stigma, and transgender stigma should be grounded in research that highlights prejudicial attitudes as they vary by the target of prejudice and the respondents’ characteristics.     

Heterosexuals’ Attitudes Toward Transgender People: Findings from a National Probability Sample of U.S. Adults

Using data from a national probability sample of heterosexual U.S. adults (N?=?2,281), the present study describes the distribution and correlates of men’s and women’s attitudes toward transgender people. Feeling thermometer ratings of transgender people were strongly correlated with attitudes toward gay men, lesbians, and bisexuals, but were significantly less favorable. Attitudes toward transgender people were more negative among heterosexual men than women. Negative attitudes were associated with endorsement of a binary conception of gender; higher levels of psychological authoritarianism, political conservatism, and anti-egalitarianism, and (for women) religiosity; and lack of personal contact with sexual minorities. In regression analysis, sexual prejudice accounted for much of the variance in transgender attitudes, but respondent gender, educational level, authoritarianism, anti-egalitarianism, and (for women) religiosity remained significant predictors with sexual prejudice statistically controlled. Implications and directions for future research on attitudes toward transgender people are discussed.     

Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.     

UNDERSTANDING WOMEN'S RISK FOR HIV INFECTION USING SOCIAL DOMINANCE THEORY AND THE FOUR BASES OF GENDERED POWER

Theoretical models to date have fallen short of accounting for the alarming worldwide rates of HIV infection in women through heterosexual contact. In this article, social dominance theory and the four bases of gendered power—force, resource control, social obligations, and consensual ideologies—are used to organize and explain international research findings on women's risk of contracting HIV from male sexual partners. Research suggests that the four bases of gendered power contribute to women having less power than men in heterosexual relationships, resulting in challenges to preventing HIV transmission from male partners. Social dominance theory also recognizes the intersections among various group-based hierarchies, such as race and class, thereby helping explain why women of color and low-income women are disproportionately affected by HIV. The intergroup focus of social dominance theory points to gender inequality as increasing men's risk of HIV infection as well, and the construct of social dominance orientation helps to explain individual differences in HIV risk behavior. We discuss the ways the current theoretical framework can prove useful in helping to guide future research addressing the connections between power and HIV risk, including exploring mediators and links to other theoretical models. We also discuss the implications the framework has for intervention efforts aimed at reducing HIV rates worldwide, such as supporting efforts at increasing women's representation in hierarchy-enhancing positions, incorporating empowerment issues into current interventions, promoting use of female condoms, and targeting heterosexual men for interventions.     

Mothers of transgender youth experience stigma-by-association

The current research investigated whether mothers of transgender youth experience stigma-by-association. Mturk participants (N = 489) were randomly assigned to read a vignette about a family in which the social identity (transgender, gay/lesbian, cisgender/heterosexual control) and gender (girl, boy) of a child was manipulated, while all other information was held constant. Results revealed stigma targeting mothers as a function of children's social identity (but not gender), such that mothers of transgender girls and boys were viewed substantially more negatively than identical mothers of cisgender/heterosexual youth. Moreover, this stigma was particularly robust among politically conservative participants. In contrast, mothers of gay/lesbian youth did not encounter systematic stigma, though they were sometimes perceived more negatively than mothers of cisgender/heterosexual youth. Results provide novel experimental evidence of stigma-by-association targeting mothers of transgender youth and raise serious concerns about the treatment of parents who seek to affirm their transgender children.     

Lazos que Atan: The Influence of Normative Gender Beliefs on Sexual Risk Behaviors of Latino Men and Women

Not all Latino men and women conform to proscribed gender roles. Nonetheless, their sexual risk taking may well be influenced by traditional beliefs concerning these roles. We explored the relationship between gender beliefs that are normative in Latino culture, and the sexual risk behaviors of 152 Latino men and women who participated in a behavioral rapid needs assessment survey in Houston, TX. Path—analytic results indicate that normative gender beliefs are influenced by respondents' sex and their levels of acculturation and that these 2 variables influence sexual risk behaviors, including unprotected sex and multi partnerism. Our results suggest that beliefs about gender influence sexual behavior and, therefore, are an important factor that should be considered in understanding sexual risk taking among Latinos.     

Agentic and Communal Personality Traits: Their Associations with Depression and Resilience among Transgender Women

Research reports the perpetuation of communal traits by transgender women, possibly to affirm their core gender identity. Transgender women in the United States are nearly 6 times more likely than the general population to experience significant depressive symptoms. Studies among non-transgender individuals in the United States demonstrate that agentic traits are associated with less depressive symptoms, while studies on communal traits are more inconsistent in their association with indicators of depression. Our study’s central objective was to examine the associations of agency and communion with depression and resilience (i.e., personal competence and acceptance of self and life) among transgender women living part-time and full-time in the female gender role. Participants in the United States were recruited through online and offline purposive sampling. One hundred and twenty-two transgender women (primarily Caucasian; ages ranging from 22 to 75) completed a web-based questionnaire. Results indicated that agentic and communal traits were significantly associated with decreased symptoms of depression and increased levels of resilience. One component of resilience – acceptance of self and life – mediated the relationship between agentic/communal traits and depression, however, for communal traits this pattern was only found for transgender women living in the female role full-time. There were no significant differences on depressive symptoms and one component of resilience - personal competence – among transgender women living full-time compared to transgender women living in the female role part-time. Transgender women living full-time in the female gender role reported higher levels of agentic/communal traits and acceptance of self and life compared to those living part-time in the female gender role. Our findings are discussed in the context of mental health among transgender women.     

Misgendering and Its Moral Contestability

In this article, I consider the harms inflicted upon transgender persons through “misgendering,” that is, such deployments of gender terms that diminish transgender persons' self‐respect, limit the discursive resources at their disposal to define their own gender, and cause them microaggressive psychological harms. Such deployments are morally contestable, that is, they can be challenged on ethical or political grounds. Two characterizations of “woman” proposed in the feminist literature are critiqued from this perspective. When we consider what would happen to transgender women upon the broad implementation of these characterizations within transgender women's social context, we discover that they suffer from two defects: they either exclude at least some transgender women, or else they implicitly foster hierarchies among women, marginalizing transgender women in particular. In conclusion, I claim that the moral contestability of gender‐term deployments acts as a stimulus to regularly consider the provisionality and revisability of our deployments of the term “woman.”     

Examining Care and Opposition in the Narratives of U.S. Local Women of Color Activists

As a result of persisting stigma, transgender people experience vastly higher rates of harassment, violence, and mental health issues compared to cisgender people. The current study experimentally evaluated a computer-mediated intergroup contact strategy, called E-contact, to reduce transgender stigma. E-contact is a synchronous, cooperative, goal-directed online interaction which is informed by Allport’s intergroup contact theory. In total, 114 cisgender, heterosexual, Australian undergraduates and community members (83 women, 31 men) were randomly allocated to E-contact with an online confederate who either disclosed that they were a transgender woman or a cisgender woman. Following the online interaction, participants then completed measures assessing prior transgender contact and transgender stigma. The findings revealed that transgender E-contact reduced stigma for cisgender men whereas it had no impact on women’s already lower levels of stigma. These novel findings have important implications for researchers, policymakers and counsellors interested in developing transgender stigma reduction interventions by (a) highlighting the importance of transgender contact for those individuals with low or poor prior contact and (b) targeting prejudice-prone populations, such as men, who stand to gain the most from such cooperative, goal-directed interventions.

     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.     

TO BE FEMALE, MIDDLE CLASS, ANXIOUS, AND BLACK

Women of color theorists have suggested that the double minority status of gender and ethnicity places African American women at higher risk for anxiety. However, little information is available about anxiety disorders among African American women. The existing literature subsumes Black women under the general category of African Americans and focuses on low-income samples. In this study, we examine the manifestation of panic disorder in a sample of 15 predominantly middle-class African American women. We then compare these women to a group of 35 predominantly middle-class African American women without panic disorder on several factors, including presence of isolated sleep paralysis, presence of other anxiety disorders, help-seeking behavior, and victimization. Results indicate that African American women with panic disorder experienced isolated sleep paralysis, and that both groups had high levels of sexual victimization. Help-seeking among women with panic and other anxiety disorders was limited to relationship difficulties, sexual assault, and bereavement.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.     

Violence against transgender people: A review of United States data

Transgender people face many challenges in a society that is unforgiving of any system of gender that is not binary. However, there are three primary sources of data in the United States for discerning the rates and types of violence that transgender people face throughout their lives — self-report surveys and needs assessments, hot-line call and social service records, and police reports. Data from each of these sources are discussed in length, as well as some of the methodological issues for these types of data sources. All three sources indicate that violence against transgender people starts early in life, that transgender people are at risk for multiple types and incidences of violence, and that this threat lasts throughout their lives. In addition, transgender people seem to have particularly high risk for sexual violence. Future research considerations, such as improving data collection efforts, are discussed.     

Alcohol use, expectancies, and sexual sensation seeking as correlates of HIV risk behavior in heterosexual young adults.

Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking.     

Transgender Youth of Color and Resilience: Negotiating Oppression and Finding Support

This qualitative study explored the resilience of 13 transgender youth of color in the southeastern region of the U.S. The definition of resilience framing this study was a participant’s ability to “bounce back” from challenging experiences as transgender youth of color. Using a phenomenological research tradition and a feminist, intersectionality (intercategorical) theoretical framework, the research question guiding the study was: “What are the daily lived experiences of resilience transgender youth of color describe as they negotiate intersections of transprejudice and racism?” The researchers’ individuated findings included five major domains of the essence of participants’ daily lived experiences of resilience despite experiencing racism and transprejudice: (1) evolving, simultaneous self-definition of racial/ethnic and gender identities, (2) being aware of adultism experiences, (3) self-advocacy in educational systems, (4) finding one’s place in the LGBTQQ (lesbian, gay, bisexual, transgender, queer, questioning) youth community, and (5) use of social media to affirm one’s identities as a transgender youth of color. Implications for practice, research, and advocacy, in addition to the study’s limitations are discussed.     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.