The Experts below are selected from a list of 52296 Experts worldwide ranked by ideXlab platform
Sari L Reisner - One of the best experts on this subject based on the ideXlab platform.
-
global epidemiology of hiv infection and related syndemics affecting Transgender people
Journal of Acquired Immune Deficiency Syndromes, 2016Co-Authors: Tonia Poteat, Sari L Reisner, Ayden I Scheim, Jessica Xavier, Stefan BaralAbstract:Introduction Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on Transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among Transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for Transgender populations. Methods A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among Transgender populations. Results Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for Transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in Transgender populations. Discussion Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by Transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on Transgender health; and understanding how to effectively implement HIV interventions for Transgender people.
-
Prevalence of Transgender Depends on the “Case” Definition: A Systematic Review
Journal of Sexual Medicine, 2016Co-Authors: Lindsay Collin, Vin Tangpricha, Sari L Reisner, Michael GoodmanAbstract:Introduction A systematic review and meta-analysis was conducted to evaluate how various definitions of Transgender affect prevalence estimates. Aims To evaluate the epidemiology of Transgender and examine how various definitions of Transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods. Methods PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of Transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of Transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity. Main Outcome Measures The main outcome measure was population prevalence of Transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups. Results Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9–13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6–9.1) for Transgender-related diagnoses. Of studies assessing self-reported Transgender identity, the mP was 871 (95% CI = 519–1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144–566). Significant heterogeneity was observed in most analyses. Conclusion The empirical literature on the prevalence of Transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on Transgender status and gender identity is recommended.
-
Transgender stigma and health a critical review of stigma determinants mechanisms and interventions
Social Science & Medicine, 2015Co-Authors: Sari L Reisner, Jaclyn White M Hughto, John E PachankisAbstract:Abstract Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards Transgender people in the US. Results This review demonstrates that Transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of Transgender people. The applied social ecological model employed here elucidates that Transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in Transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US Transgender populations. Multi-level interventions to prevent stigma towards Transgender people are warranted.
-
comprehensive Transgender healthcare the gender affirming clinical and public health model of fenway health
Journal of Urban Health-bulletin of The New York Academy of Medicine, 2015Co-Authors: Sari L Reisner, Judith Bradford, Ruben Hopwood, Alex Gonzalez, Harvey J Makadon, David TodiscoAbstract:This report describes the evolution of a Boston community health center’s multidisciplinary model of Transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where Transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for Transgender people. Fenway Health’s holistic public health efforts recognize the key role of gender affirmation in the care and well-being of Transgender people worldwide.
-
Transgender health disparities comparing full cohort and nested matched pair study designs in a community health center
LGBT health, 2014Co-Authors: Sari L Reisner, Judith Bradford, Jaclyn M White, Matthew J MimiagaAbstract:Abstract Purpose: U.S. health surveillance systems infrequently include measures to identify Transgender respondents or monitor the health of this underserved and marginalized population. Methods: From 2001 to 2002, Transgender and nonTransgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by Transgender identity using a cross-sectional, clinic-based sample (n=2,653) and a nested matched-pair subsample (n=155). Results: Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for Transgender and nonTransgender patients; (2) Transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared with nonTransgender patients (p<0.05); (3) Transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to nonTransgender patients (p<0.05). Conclusion: Findings suggest that a nested design may provide an ...
Judith Bradford - One of the best experts on this subject based on the ideXlab platform.
-
comprehensive Transgender healthcare the gender affirming clinical and public health model of fenway health
Journal of Urban Health-bulletin of The New York Academy of Medicine, 2015Co-Authors: Sari L Reisner, Judith Bradford, Ruben Hopwood, Alex Gonzalez, Harvey J Makadon, David TodiscoAbstract:This report describes the evolution of a Boston community health center’s multidisciplinary model of Transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where Transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for Transgender people. Fenway Health’s holistic public health efforts recognize the key role of gender affirmation in the care and well-being of Transgender people worldwide.
-
Transgender health disparities comparing full cohort and nested matched pair study designs in a community health center
LGBT health, 2014Co-Authors: Sari L Reisner, Judith Bradford, Jaclyn M White, Matthew J MimiagaAbstract:Abstract Purpose: U.S. health surveillance systems infrequently include measures to identify Transgender respondents or monitor the health of this underserved and marginalized population. Methods: From 2001 to 2002, Transgender and nonTransgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by Transgender identity using a cross-sectional, clinic-based sample (n=2,653) and a nested matched-pair subsample (n=155). Results: Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for Transgender and nonTransgender patients; (2) Transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared with nonTransgender patients (p<0.05); (3) Transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to nonTransgender patients (p<0.05). Conclusion: Findings suggest that a nested design may provide an ...
-
experiences of Transgender related discrimination and implications for health results from the virginia Transgender health initiative study
American Journal of Public Health, 2013Co-Authors: Judith Bradford, Sari L Reisner, Julie A Honnold, Jessica XavierAbstract:Objectives. We examined relationships between social determinants of health and experiences of Transgender-related discrimination reported by Transgender people in Virginia.Methods. In 2005 through 2006, 387 self-identified Transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper).Results. Of participants, 41% (n = 143) reported experiences of Transgender-related discrimination. Factors associated with Transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first Transgender awareness), health care needed...
Joshua D. Safer - One of the best experts on this subject based on the ideXlab platform.
-
Gaps in Transgender medical education among healthcare providers: A major barrier to care for Transgender persons.
Reviews in endocrine & metabolic disorders, 2018Co-Authors: Sira Korpaisarn, Joshua D. SaferAbstract:A lack of access to knowledgeable providers is the greatest reported barrier to care for Transgender individuals. The purpose of this manuscript is to review the recent literature characterizing Transgender medicine education for medical providers and to summarize effective interventions for improving education in Transgender care. The PubMed database was searched for all literature that assessed Transgender medical education among physicians or trainees and all papers that reported results of Transgender-specific educational interventions. Literature that only evaluated general lesbian, gay, bisexual, and Transgender (LGBT) educational interventions was excluded. The lack of education in Transgender care continues among providers across all levels of medical education from medical students and physician trainees to primary care providers, endocrinologists and other specialists involved in Transgender care. Several interventions have been shown to effectively improve Transgender knowledge and cultural competency. Education among healthcare providers is deficient and is considered a major barrier to care for Transgender individuals. Effective interventions should be applied to fundamental medical education. Additional focused education also should be taught with specialty-appropriate content to produce needed proficiency among providers of Transgender care.
-
Hormone therapy in Transgender adults is safe with provider supervision; A review of hormone therapy sequelae for Transgender individuals
Journal of clinical & translational endocrinology, 2015Co-Authors: Jamie D. Weinand, Joshua D. SaferAbstract:Abstract Introduction Some providers report concern for the safety of Transgender hormone therapy (HT). Methods This is a systematic literature review of HT safety for Transgender adults. Results Current literature suggests HT is safe when followed carefully for certain risks. The greatest health concern for HT in Transgender women is venous thromboembolism. HT among Transgender men appears to cause polycythemia. Both groups experienced elevated fasting glucose. There is no increase in cancer prevalence or mortality due to Transgender HT. Conclusion Although current data support the safety of Transgender HT with physician supervision, larger, long-term studies are needed in Transgender medicine.
Stefan Baral - One of the best experts on this subject based on the ideXlab platform.
-
global epidemiology of hiv infection and related syndemics affecting Transgender people
Journal of Acquired Immune Deficiency Syndromes, 2016Co-Authors: Tonia Poteat, Sari L Reisner, Ayden I Scheim, Jessica Xavier, Stefan BaralAbstract:Introduction Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on Transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among Transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for Transgender populations. Methods A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among Transgender populations. Results Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for Transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in Transgender populations. Discussion Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by Transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on Transgender health; and understanding how to effectively implement HIV interventions for Transgender people.
-
Serving Transgender people: clinical care considerations and service delivery models in Transgender health
Lancet (London England), 2016Co-Authors: Kevan Wylie, Gail Knudson, Sharful Islam Khan, Mireille Bonierbale, Suporn Watanyusakul, Stefan BaralAbstract:The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, Transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for Transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for Transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in Transgender health, although the best evidence supports introducing modules on Transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in Transgender health-care decisions, effective models of health service provision, and available surgical interventions for Transgender people.
-
worldwide burden of hiv in Transgender women a systematic review and meta analysis
Lancet Infectious Diseases, 2013Co-Authors: Stefan Baral, Tonia Poteat, Susanne Stromdahl, Andrea L Wirtz, Thomas E Guadamuz, Chris BeyrerAbstract:Summary Background Previous systematic reviews have identified a high prevalence of HIV infection in Transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in Transgender women worldwide. We aimed to better assess the relative HIV burden in all Transgender women worldwide. Methods We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in Transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in Transgender women with that in adults in the countries for which data were available. Findings Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4–20·7) in 11 066 Transgender women worldwide. In 7197 Transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6–19·8). In 3869 Transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8–24·3). The odds ratio for being infected with HIV in Transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2–76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries. Interpretation Our findings suggest that Transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among Transgender women. Funding Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.
Jill L. Adelson - One of the best experts on this subject based on the ideXlab platform.
-
Transgender community belongingness as a mediator between strength of Transgender identity and well-being.
Journal of counseling psychology, 2016Co-Authors: Sebastian M. Barr, Stephanie L. Budge, Jill L. AdelsonAbstract:This study examined Transgender community belongingness as a mediator between strength of Transgender identity and well-being. A total of 571 Transgender adults (n = 209 Transgender women, n = 217 Transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing Transgender community belongingness, strength of Transgender identity (operationalized as the extent to which a person self-categorizes their identity as Transgender and the extent to which they believe their gender transition to be important to their self-definition), and well-being (using measures of self-esteem, satisfaction with life, and psychological well-being). Structural equation modeling was used to analyze the data. When controlling for participants' income, age, and stage of gender transition, Transgender community belongingness fully mediated the relationship between strength of Transgender identity and well-being. Strength of Transgender identity was indirectly and positively related to well-being through community belongingness, but was not directly related to well-being. Results suggest that Transgender community belongingness is an important construct in the mental health of Transgender people. The strength of a person's Transgender identity also appears to be a significant construct in Transgender people's well-being via its relationship with Transgender community belongingness. Implications of the findings are discussed. (PsycINFO Database Record
-
anxiety and depression in Transgender individuals the roles of transition status loss social support and coping
Journal of Consulting and Clinical Psychology, 2013Co-Authors: Stephanie L. Budge, Jill L. Adelson, Kimberly A S HowardAbstract:Objective The purpose of the current study was to examine facilitative and avoidant coping as mediators between distress and transition status, social support, and loss. Method A total of 351 Transgender individuals (n = 226 Transgender women and n = 125 Transgender men) participated in this study. Participants completed measures on Transgender identity, family history of mental health concerns, perceptions of loss, coping, depression, and anxiety. Results The rates of depressive symptoms (51.4% for Transgender women; 48.3% for Transgender men) and anxiety (40.4% for Transgender women; 47.5% for Transgender men) within the current study far surpass the rates of those for the general population. Structural equation modeling (SEM) was used to analyze the data-2 separate models were hypothesized, based on reports of anxiety or depression. The SEM results suggest that the processes for Transgender women and Transgender men are primarily similar for depression and anxiety; avoidant coping served as a mediator between transition status and both distress variables. Social support was directly related to distress variables, as well as indirectly related through avoidant coping. Conclusion Results suggest the need for practitioners to focus on interventions that reduce avoidant coping strategies, while simultaneously increasing social support, in order to improve mental health for Transgender individuals. Individuals who are in the beginning stages of their transition will use different coping strategies than those who are in later stages; interventions should be adjusted on the basis of the transition status of Transgender clients.
