"It's behaviors, not identity": Attitudes and beliefs related to HIV risk and pre-exposure prophylaxis among transgender women in the Southeastern United States.
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ABSTRACT:
SUBMITTER: Van Gerwen OT
PROVIDER: S-EPMC8794203 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Providers are central to effective implementation of HIV pre-exposure prophylaxis (PrEP). Primary care providers (PCP) and infectious disease physicians (ID) in the US Air Force (USAF) participated in a cross-sectional survey regarding knowledge, attitudes, and beliefs toward HIV PrEP. Characteristics associated with PrEP knowledge were assessed in univariate and multivariate analyses.Among 403 (40% of 1015 providers) participants, 9% (PCP 383, ID 20) ever prescribed PrEP. In univariate analysis, years in practice, number of HIV-infected patients treated in the past 12 months, past prescription of antiretrovirals for HIV prevention, frequency of prescribing PrEP in the past 12 months, and ever being questioned by a patient about PrEP were associated with PrEP knowledge (P?<?0.05). In multivariate analysis, providers who had ever prescribed antiretrovirals to prevent HIV (AOR: 2.37, 95% CI: 1.27-4.42) had greater odds of high PrEP knowledge. Despite concerns about medication side effects (overall 67%: PCP 68%, ID 85%) and prescribing PrEP without clear evidence (overall 60%: PCP 65%, ID 62%), 64% (PCP 65%, ID 85%) of participants indicated PrEP should be offered in the Military Health System and 68% (PCP 70%, ID 100%) disagreed with the statement that their patient population was not at risk for HIV infection.Successful PrEP implementation in the USAF will require continued education and training of primary care providers to improve knowledge and mitigate concerns about PrEP.
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Project description:Children essentialize gender from a young age, viewing it as inborn, biologically based, unchanging, and predictive of preferences and behaviors. Children's gender essentialism appears to be so pervasive that it is found within conservative and liberal communities, and among transgender and cisgender children. However, it remains unclear what aspect of gender the children participating in past studies essentialized. Such studies used labels such as "girl" or "boy" without clarifying how children (or researchers) interpreted them. Are they indicators of the target's biological categorization at birth (sex), the target's sense of their own gender (gender identity), or some third possible interpretation? This distinction becomes particularly relevant when transgender children are concerned, as their sex assigned at birth and gender identity are not aligned. In the present two studies, we discovered that 6- to 11-year-old transgender children, their cisgender siblings, and unrelated cisgender children, all essentialized both sex and gender identity. Moreover, transgender and cisgender children did not differ in their essentialism of sex (i.e., whether body parts would remain stable over time). Importantly, however, transgender children were less likely than unrelated cisgender children to essentialize when hearing an ambiguous gender/sex label ("girl" or "boy"). Finally, the two studies showed mixed findings on whether the participant groups differed in reasoning about the stability of a gender-nonconforming target's gender identity. These findings illustrate that a child's identity can relate to their conceptual development, as well as the importance of diversifying samples to enhance our understanding of social cognitive development.
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Project description:America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.
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Project description:ObjectiveThe number of transgender and gender non-conforming children is on the rise. For these children, the timing of medical intervention is crucial, yet transgender children report poorer overall physical and mental health outcomes compared with their cisgender peers. We aim to describe how paediatricians perceive transgender people.SettingThe 'Transgender Attitudes and Beliefs Scale', which consists of 29 items in three domains-human value, interpersonal comfort and sex/gender beliefs-was administered to 391 senior and resident paediatricians in Israel. The responses on a 7-point Likert scale were collapsed into two categories: a mean score of ≥6 for each domain was a 'Favourable' perception and <6 'Unfavourable'.ResultsOf 355 respondents (91% response rate), 221 (62%) were females, 132 (37%) were males and 2 identified as 'other'; 290 (82%) were born in 'trans-respect countries', 274 (77%) identified as secular, 223 (63%) were senior physicians and 132 (27%) were residents. Overall, 90% of the cohort scored favourably on the 'Human value' domain, 68% on 'Interpersonal comfort' and 40% on 'Sex/gender beliefs'. In the 'Interpersonal comfort' domain, being a man, birthplace in a transphobic country, identification as religious and being a senior physician were all associated with increased ORs for an unfavourable score: 2.1 (95% CI 1.3 to 3.4), 3.4 (95% CI 1.9 to 6.3), 2.4 (95% CI 1.4 to 4.2) and 1.8 (95% CI 1.1 to 3.0), respectively. In the 'Sex/gender beliefs' domain, being a man and identifying as religious had significantly increased ORs for unfavourable scores: 2.2 (95% CI 1.3 to 3.5) and 10.6 (95% CI 4.7 to 24.1), respectively.ConclusionsNegative attitudes towards transgender people are still widespread among paediatricians. Interventions are warranted to positively impact these attitudes.
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Project description:Purpose: In Argentina, transgender women face a disproportionately high prevalence of HIV infection (34%). Although not currently approved in Argentina, pre-exposure prophylaxis (PrEP) may offer a potential effective HIV prevention tool for this population. In this study, we assessed the willingness to use PrEP among transgender women in Argentina. Methods: Data were drawn from a nationwide cross-sectional survey conducted among transgender women in 2013. Using multivariable logistic regression, we assessed the prevalence of and factors associated with willingness to use PrEP among transgender women with negative or unknown HIV status. Results: This study included 337 transgender women (278 HIV negative and 59 with unknown HIV status), most of whom had a history of sex work involvement (81.8%). Overall, 301 (89.3%) expressed willingness to use PrEP. In a multivariable analysis, having casual sexual partners was positively associated with willingness to use PrEP (adjusted odds ratio [AOR]=4.26, 95% confidence interval [CI] 1.73-10.51), while discrimination by healthcare workers was negatively associated (AOR=0.33, 95% CI 0.12-0.88). Conclusion: We found high levels of willingness to use PrEP among transgender women in Argentina, suggesting that there is high perception of HIV risk in this population. However, discrimination by healthcare workers was a strong negative correlate of willingness to use PrEP, suggesting that multilevel interventions that address gender-based stigma in healthcare settings will be critical for the success of PrEP as an HIV prevention strategy in this population.
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Project description:BackgroundTransgender men (TGM) are underrepresented in genital microbiome research. Our prospective study in Birmingham, AL investigated genital microbiota changes over time in TGM initiating testosterone, including the development of incident bacterial vaginosis (iBV). Here, we present lessons learned from recruitment challenges encountered during the conduct of this study.MethodsInclusion criteria were assigned female sex at birth, TGM or non-binary identity, age ≥18 years, interested in injectable testosterone but willing to wait 7 days after enrollment before starting, and engaged with a testosterone-prescribing provider. Exclusion criteria were recent antibiotic use, HIV/STI infection, current vaginal infection, pregnancy, or past 6 months testosterone use. Recruitment initiatives included community advertisements via flyers, social media posts, and referrals from local gender health clinics.ResultsBetween February 2022 and October 2023, 61 individuals contacted the study, 17 (27.9%) completed an in-person screening visit, and 10 (58.8%) of those screened were enrolled. The primary reasons for individuals failing study screening were having limited access to testosterone-prescribing providers, already being on testosterone, being unwilling to wait 7 days to initiate testosterone therapy, or desiring the use of topical testosterone. Engagement of non-White TGM was also minimal.ConclusionDespite robust study inquiry by TGM, screening and enrollment challenges were faced including engagement by TGM not yet in care and specific study eligibility criteria. Excitement among TGM for research representation should be leveraged in future work by engaging transgender community stakeholders at the inception of study development, particularly regarding feasibility of study inclusion and exclusion criteria, as well as recruitment of TGM of color. These results also highlight the need for more clinical resources for prescribing gender-affirming hormone therapy, especially in the Southeastern US.
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Project description:Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals' perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake.
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Project description:Introduction/objectivesPre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers.MethodsWe developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher's exact tests, respectively.ResultsOf 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, P < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, P < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, P = .01) and comfort taking a sexual history (92% vs 63%, P < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%).ConclusionPrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.
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Project description:Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.
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Project description:Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.
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