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Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV

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Abstract

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.

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References

  1. American Medical Association. Resolution 122—removing financial barriers to care for transgender patients, 2008.

  2. Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, Keisling M. National Transgender Discrimination Survey Report on health and health care: National Center for Transgender Equality, 2010; Washington, DC.

  3. Stroumsa D. The state of transgender health care: policy, law, and medical frameworks. Am J Public Health. 2014; 104(3): e31–8. doi:10.2105/AJPH.2013.301789.

    Article  PubMed  Google Scholar 

  4. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012; 4(151ra25): 151. doi:10.1126/scitranslmed.3004006.

    Google Scholar 

  5. Grossman AH, D’Augelli AR. Transgender youth: invisible and vulnerable. J Homosex. 2006; 51(1): 111–28.

    Article  PubMed  Google Scholar 

  6. Blosnich JR, Brown GR, Shipherd Phd JC, Kauth M, Piegari RI, Bossarte RM. Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. Am J Public Health. 2013; 103(10): e27–e32. doi:10.2105/AJPH.2013.301507.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Nuttbrock L, Hwahng S, Bockting W, et al. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res. 2009; 47(1): 1–12.

    Google Scholar 

  8. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001; 91(6): 915–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res. 2010; 19(7): 1019–24. doi:10.1007/s11136-010-9668-7.

    Article  PubMed  Google Scholar 

  10. Gorin-Lazard A, Baumstarck K, Boyer L, et al. Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. J Sex Med. 2012; 9(2): 531–41. doi:10.1111/j.1743-6109.2011.02564.x.

    Article  PubMed  Google Scholar 

  11. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health. 2013; 103(10): 1830–36. doi:10.2105/AJPH.2013.301348.

    Article  PubMed  Google Scholar 

  12. DeSantis JP, Patsdaughter CA. Which came first-the chicken or the egg? the cycle of abuse, violence, and/or neglect and HIV. J Assoc Nurses AIDS Care: JANAC. 2013; 24(4): 285–7. doi:10.1016/j.jana.2013.04.002.

    Article  PubMed  Google Scholar 

  13. Nuttbrock L, Bockting W, Rosenblum A, et al. Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health. 2013; 103(2): 300–7. doi:10.2105/AJPH.2011.300568.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Xavier J, Honnold JA, Bradford J. The health, health-related needs, and lifecourse experiences of transgender Virginians. In: Policy CfP, ed. Community Health Research Initiative: Virginia Commonwealth University, 2007.

  15. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006; 51(3): 53–69.

    Article  PubMed  Google Scholar 

  16. Santos GM, Rapues J, Wilson EC, et al. Alcohol and substance use among transgender women in San Francisco: prevalence and association with human-immunoficiency virus infection. Drug and Alcohol Review. 2014; 33(3): 287–95. doi: 10.1111/dar.12116.

  17. Benotsch EG, Zimmerman R, Cathers L, et al. Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend. 2013; 132(1–2): 391–4. doi:10.1016/j.drugalcdep.2013.02.027.

    Article  PubMed  Google Scholar 

  18. Bowers JR, Branson CM, Fletcher J, Reback CJ. Differences in substance use and sexual partnering between men who have sex with men, men who have sex with men and women and transgender women. Cult, Health Sex. 2011; 13(6): 629–42. doi:10.1080/13691058.2011.564301.

    Article  Google Scholar 

  19. Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013; 68(11–12): 675–89. doi:10.1007/s11199-012-0216-5.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Herrick AL, Stall R, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2014; 18(1): 1–9. doi:10.1007/s10461-012-0384-x.

    Article  PubMed  Google Scholar 

  21. Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005; 19(Suppl 2): S67–72.

    Article  PubMed  Google Scholar 

  22. Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden population. Soc Probl. 1997; 44(2): 174–99.

    Article  Google Scholar 

  23. Rapues J, Wilson EC, Packer T, Colfax GN, Raymond HF. Correlates of HIV infection among transfemales, San francisco, 2010: results from a respondent-driven sampling study. Am J Public Health. 2013; 103(8): 1485–92. doi:10.2105/AJPH.2012.301109.

    Article  PubMed  Google Scholar 

  24. Campbell MS, Gottlieb GS, Hawes SE, et al. HIV-1 superinfection in the antiretroviral therapy era: are seroconcordant sexual partners at risk? PLoS One. 2009; 4(5): e5690. doi:10.1371/journal.pone.0005690.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Volz E, Wejnert C, Cameron C, et al. Respondent-driven sampling analysis tool (RDSAT) version 7.1. Ithaca, NY: Cornell University; 2012.

    Google Scholar 

  26. Team RDC. R: A language and environment for statistical computing. Secondary R: A language and environment for statistical computing. 2012. http://www.R-project.org/. Accessed January 2013.

  27. Lumley T. Complex surveys: a guide to analysis using R. Hoboken NJ: Wiley; 2010.

    Book  Google Scholar 

  28. Weyers S, Elaut E, De Sutter P, et al. Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med. 2009; 6(3): 752–60. doi:10.1111/j.1743-6109.2008.01082.x.

    Article  PubMed  Google Scholar 

  29. Testa RJ, Sciacca LM, Wang F, et al. Effects of violence on transgender people. Prof Psychol: Res Pract. 2012; 43(5): 452–59. doi:10.1037/a0029604.

    Article  Google Scholar 

  30. Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001; 91(11): 1869–76.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Nemoto T, Operario D, Keatley J, Han L, Soma T. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Public Health. 2004; 94(7): 1193–9.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Sausa LA, Keatley J, Operario D. Perceived risks and benefits of sex work among transgender women of color in San Francisco. Arch Sex Behav. 2007; 36(6): 768–77. doi:10.1007/s10508-007-9210-3.

    Article  PubMed  Google Scholar 

  33. Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013; 84: 22–9. doi:10.1016/j.socscimed.2013.02.019.

    Article  PubMed  Google Scholar 

  34. Sanchez NF, Sanchez JP, Danoff A. Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health. 2009; 99(4): 713–9. doi:10.2105/AJPH.2007.132035.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Wilson EC, Arayasirikul S, Johnson K. Access to HIV care and support services for African American transwomen living with HIV. Int J Transgend. 2014; 14(4): 182–95.

    Article  Google Scholar 

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Acknowledgments

We would like to thank the participants for their for their willingness to contribute to this study. In addition, we would like to thank the project staff who made data collection possible, including Sean Arayasirikul, Marla Fisher, Andres Pomart and Victory Le. This study was supported by a grant from the National Institute of Mental Health - grant # R01MH095598.

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Authors and Affiliations

  1. San Francisco Department of Public Health, 25 Van Ness, suite 500, San Francisco, CA, 94102, USA

    Erin C. Wilson, Yea-Hung Chen, Sean Arayasirikul, Conrad Wenzel & H. Fisher Raymond

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  1. Erin C. Wilson
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  2. Yea-Hung Chen
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Correspondence to Erin C. Wilson.

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Wilson, E.C., Chen, YH., Arayasirikul, S. et al. Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV. J Urban Health 92, 182–192 (2015). https://doi.org/10.1007/s11524-014-9921-4

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