Search Results (115)

Background: Black transgender women experience high rates of intersectional discrimination contributing to post-traumatic stress disorder (PTSD) symptoms. While sleep typically buffers psychological distress among general populations, these relationships remain underexplored among Black transgender women, and existing protective sleep literature derives primarily from non-Hispanic White, cisgender, socioeconomically advantaged populations. Methods: This exploratory secondary cross-sectional analysis of 155 Black transgender women (aged 18+) examined whether sleep quality (Pittsburgh Sleep Quality Index) moderates associations between discrimination (Intersectional Discrimination Index) and PTSD symptoms (PTSD Symptom Checklist-DSM-5) using moderated multiple linear regression models, controlling for age (n = 139–149). Results: Contrary to expectations, better sleep quality strengthened associations between day-to-day (p = 0.0126) and major discrimination (p = 0.0235) and the PTSD symptom severity. Conclusions: These exploratory findings reveal paradoxical sleep-distress relationships among Black transgender women that contradict patterns documented among general populations, highlighting critical limitations in applying existing psychological frameworks to multiple marginalized communities. Results underscore urgent needs for culturally validated assessment instruments and comprehensive measurement of structural determinants (housing stability, economic security, and neighborhood safety) before concluding psychology in populations experiencing intersectional oppressions. Full article

This paper will discuss the depiction of trans women in the films Lovely Man and Midnight Swan, comparing the two main characters, Ipuy and Nagisa. Discrimination against transgender individuals persists in contemporary society, particularly in patriarchal Asian countries such as Indonesia and Japan. The films Lovely Man and Midnight Swan are of Indonesian and Japanese origin, respectively. A close analysis of both films reveals that they feature protagonists who embody the exact symbolic representations as entertainers, parents, sexual objects, and pariahs. According to Peirce’s semiotics, these four symbolic representations are determined. A thorough examination of the cinematic expressive movements in both films reveals four metaphorical expressions: the trans woman as an entertainer, the trans woman as a parent, the trans woman as a sexual object, and the trans woman as a pariah. These four metaphorical expressions are validated through extralinguistic references, reflecting socio-cultural realities in Indonesian and Japanese societies. They become arguments through the interpretation of both films. The similarities between the two films can be understood as a social critique of the issues facing trans women in Indonesia and Japan, who require greater attention to their human rights to survive in society. Full article

The objective of the study is to describe the health status and use of public healthcare services by undocumented migrant sex workers (UMSWs) attended in Catalonia between 2013 and 2018. This study utilized a descriptive observational research design. Non-parametric tests were applied to estimate differences in the use of public healthcare services, and incidence and prevalence of selected sexually transmitted diseases (STDs) according to gender and region of origin. Out of 1464 women and 199 men UMSWs, 855 (51.4%) contacted primary care services once or more, and 378 (22.7%) used emergency services. Differences between regions of origin were found in the use of primary care services (Sub-Saharan Africa had 65.9% while Europe and Central Asia 43.0%, p < 0.001). Facilitating early diagnosis and improving access to healthcare resources among key populations such as men who have sex with men or transgender women can be achieved through interventions such as community-led point-of-care testing, which increases the frequency of HIV and STD screening and may also prove effective among UMSWs. Full article

The high HIV prevalence among men who have sex with men and transgender women (TW) in Peru calls for innovative HIV prevention strategies to modify social norms, increase social support and promote empowerment and community mobilization. This qualitative article presents the synergistic processes that generated community mobilization throughout Generación Actual (GA, Current Generation in English), an HIV prevention intervention with gay men (GM) and TW in Lima South based on Mpowerment, a U.S.-model intervention program. We conducted 24 interviews with GM and TW participants, informed by observations of GA and the perceptions of its implementing coordinators, and complemented by the number/types of GA activities. Four significant processes occurred throughout GA: (1) high participant engagement, community building and empowerment; (2) an effect on HIV prevention and treatment; (3) the integration of GM and TW and (4) GA’s community center becoming a safe space for socializing, support and information. These processes helped produce positive changes related to self-empowerment, personal agency and the participants’ health, suggesting an impact of GA on HIV prevention, stigma reduction and care engagement. Community mobilization strategies that ensure active community participation and involvement may constitute relevant aspects for an effective approach to HIV prevention for TW and GM in Peru. Full article

Background: Human immunodeficiency virus (HIV) affects more than 39 million people worldwide, with Uganda ranked 10th among countries with the highest number of cases. As new preventative HIV injectables emerge, it is vital to think about how best to tailor strategies to promote these injectable drugs, like PrEP and vaccines, when available, to the different populations most in need. Discrete choice experiments (DCEs) are economics-derived methods used to determine factors that influence engagement in a certain behavior. Objective: This study used a DCE to determine the preferences for a preventative HIV injectable drugs/vaccines among people at risk of HIV acquisition in urban and peri-urban areas of Uganda. Methods: In June 2024, we implemented a cross-sectional DCE survey in three urban sites in Uganda in English and Luganda. The survey collected information on demographics, HIV risk, vaccine confidence and responses to the 13 injection product choice tasks presented to determine preferences. We used community-based, respondent-driven sampling methods to recruit participants from three key populations: (1) female sex workers; (2) people who identify as lesbian, gay, bisexual or transgender; and (3) young women (18–24 years). We collected the data on tablets using the Sawtooth Lighthouse Studio software (v. 19.15.6), taking into consideration privacy and confidentiality, given the sensitivity of the information and recent governmental policies in Uganda. Data were analyzed using a split-sample mixed logit regression analysis. The study was approved by local ethical regulatory bodies. Results: From the total of 406 participants screened for this study, 376 participants met the eligibility criteria and were included in the final analysis (85 young women, 159 female sex workers, and 132 who identified as lesbian, gay, bisexual or transgender). The average age was 23.7 (SD: 5.7). The majority of participants had received some secondary school or vocational school (202, 53.7%) The attributes that explained the preferences were primarily severe compared to mild side effects (β: −0.69, 95% CI: −0.78, −0.60), a 30% increase in vaccine/drug effectiveness (β: 0.39, 95% CI: 0.34, 0.44), and a 50,000 UGX (or USD ~13.64) increase in cost (β: −0.22, 95% CI: −0.27, −0.17). There were no significant differences between the preferences for different injectable types. The sensitivity analyses suggested potential differences in preferences by the amount of help participants received from research assistants when completing the survey, although not by income level. Conclusions: Side effects had the greatest impact on participants’ preferences for injectable HIV prevention methods, followed closely by effectiveness and cost. It is therefore essential to develop affordable or free prevention options with minimal side effects. Policymakers should focus on reducing the financial barriers to access and emphasize transparent communication about the effectiveness and safety of these injectables in health promotion campaigns to maximize adoption and improve public health outcomes. Full article

Nutrition is a cornerstone of public health, yet the unique nutrition needs and considerations of lesbian, gay, bisexual, transgender, and others (LGBT+) communities remain largely invisible in the field of dietetics. These populations face disproportionate burdens of obesity, eating disorders, body dysmorphia, metabolic risks, and food insecurity, often driven by stigma, minority stress, and structural inequities. This narrative review aimed to synthesize current evidence on nutrition-related disparities among LGBT+ populations and identify opportunities for dietitians to advance equity in care. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies addressing diet quality, obesity, eating disorders, food insecurity, and metabolic health in sexual and gender minorities. Evidence indicates clear subgroup differences: lesbian and bisexual women are more likely to experience obesity and food insecurity; gay and bisexual men report lower BMI but greater body image concerns and disordered eating; transgender individuals face nutritional challenges linked to gender-affirming therapy and high rates of food insecurity; and people living with HIV encounter additional metabolic risks associated with treatment. Despite these findings, LGBT+ health remains rarely reflected in dietary guidelines or professional training. Embedding inclusivity into dietetic education and clinical encounters, adopting culturally competent and structurally aware practices, and tailoring interventions to subgroup-specific needs are key priorities. Inclusive, equity-driven, and person-centered nutrition care is essential to closing health gaps for LGBT+ populations and ensuring that every patient receives guidance that affirms their identity and lived experience. Full article

This article examines the concept of female-to-male transformation in Daoism inner alchemy for women (nüdan 女丹) and Buddhism, both of which have records of female practitioners and nuns being required to transform their bodies into men, such as “women change their bodies to become men” (nühuan nanti 女換男體) in nüdan and “transform a woman into a man”(nüzhuan nanshen 女轉男身) in Buddhism. When considering these literal meanings in isolation, this can be interpreted as suggesting that these religions uphold the superiority of the male body with its physical attributes over the female body. Women who practice religious meditation must be transgender to have the possibility of becoming a Daoist immortal or an enlightened Buddhist. But is this the case? This article employs an analytical approach to examine the interpretations of the transgender concept of “female-to-male transformation” in Daoist nüdan and Buddhism. The analysis reveals the metaphorical expressive function of this concept and thereby refutes the simplistic view that equates it with gender discrimination. The present paper reveals the profound differences and commonalities between nüdan and the Buddhist concept of “female-to-male transformation” through comparative analysis of their fundamental concepts, gender metaphors, and cultivation paths. The study demonstrates that while these two traditional systems address gender and transcendence differently, both provide women with diverse paths to spiritual liberation through their unique methods of cultivation. Full article

Malaysia is an upper-middle-income country and one of the few in Asia that has achieved Universal Health Coverage (UHC). Despite this, healthcare in Malaysia is less accessible to marginalized groups, such as transgender women, because a legal framework denies them gender-appropriate identification. Healthcare settings often fall short in addressing transgender-specific health needs. Transgender women face compounded stigma and discrimination, along with unique social and interpersonal challenges that greatly increase their risk of poor overall health. This narrative review explores the barriers to accessing and using primary, sexual, oral, and mental healthcare for transgender women in Malaysia. The discussion covers enabling factors like training healthcare workers, prioritizing transgender health needs, working with community-led organizations, implementing health policy reforms, and utilizing technology-based health interventions. Full article

Gender-neutral terms such as “sex work” and “sex worker” have gained prominence in academic, activist, and policy discourses. Unlike terms such as ‘prostitutes’ and ‘prostitution,’ these terms serve to reduce stigma and emphasize the labor involved in sex work. However, numerous studies suggest that these terms carry different meanings across cultural contexts, and their impact is experienced differently by various sub-groups of sex workers. Although originally coined by American activist Carol Leigh to unify sex workers across genders and sectors, these terms are, in some settings—including Kolkata, India—met with silence, coded language, or secrecy, particularly among transient sex workers, including cisgender and transgender women. As researchers with two decades of ethnographic research with 46 cisgender and 37 transgender women engaged in sex work in Kolkata and Eastern India, the authors argue that such silence and non-verbal forms of communication should not be interpreted merely as ignorance or disengagement but rather as strategic/willful acts of agency or resistance. These practices enable sex workers situated in different contexts to navigate unequal power dynamics within NGOs, manage respectability, mitigate structural violence, and foster communal identity. By examining how diverse groups of sex workers employ silence and secrecy, this study contributes to a more nuanced and empathetic understanding of the complexities surrounding the former’s lives and their agency. The study results indicate that it is essential for scholars, advocates and activists to employ strengths-based, context-specific language and research practices to be able to hear the stories of subaltern groups like commercial sex workers. It is also suggested that training of service providers and helping professionals focus on accepting and honoring the language people use to identify themselves in varied spaces and contexts. Full article

HIV disproportionately affects key populations (MSM, transgender people, sex workers and psychoactive substance users), who face greater social vulnerability and limited healthcare access. This study aimed at analyzing sexual orientation and gender identity and their association with sexual practices, sexually transmitted infections and psychoactive substance use among PrEP users. Method: A cross-sectional study was conducted between January 2018 and June 2021 with 736 Brazilian PrEP users from a health service in São Paulo. Sociodemographic data, sexual behaviors, STI history (past 3 months) and psychoactive substances use (past 3 months) were extracted from clinical records. The associations were analyzed using binomial logistic regression (p < 0.05). Results: Most of the participants were cisgender men (93.4%) and homosexual (84.8%), with a mean age of 34.9 years old. Condomless sex was reported by 98.5%, and 18.4% had some recent sexually transmitted infection, mainly syphilis. Psychoactive substance use was reported by 55.4%, especially marijuana, club drugs, erectile stimulants and poppers. Transgender and cisgender women were more likely to report sex work and crack use. Homosexual and bisexual participants had higher odds of using erectile stimulants. Conclusions: The study reveals key links between gender, sexual orientation and risk behaviors, highlighting the need for inclusive, targeted prevention. Full article

Sexual minority women (SMW) are a resilient yet vulnerable population who may experience poor psychosocial outcomes due to minority stress associated with their marginalized status and traumatic experiences resulting from interpersonal and structural violence. When SMW are incarcerated, the trauma of this experience can exacerbate existing mental health challenges. Self-concept is a key measure of mental health that is associated with increased self-efficacy and positive psychosocial outcomes. This analysis explores the ways in which incarceration impacts the self-concept of SMW. Secondary data analysis of three qualitative interviews with formerly incarcerated SMW was conducted. Specifically, Gilligan’s Listening Guide was used to create “I poems” that articulate the participants’ narratives and contrapuntal voices. These poems were then analyzed to build knowledge about participants’ self-concept. This analysis informs our understandings of self-concept among SMW, violence against women, the vulnerability of binary constructs, and the ways in which people negotiate past, present and future selves. The findings can inform interventions that seek to mitigate the psychosocial risks faced by SMW and formerly incarcerated people and improve outcomes for these populations. Full article

Cervical cancer remains one of the main causes of female mortality, especially in middle- and low-income countries, despite efforts towards the implementation of global vaccination against human papillomavirus (HPV). The aim of this study was to review and compare the most recently published international guidelines providing recommendations on cervical cancer screening strategies among average and high-risk women. Thus, a comparative review of guidelines by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), the World Health Organization (WHO), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cancer Council Australia (CCA), and the European Guidelines (EG) was conducted. There is an overall agreement regarding the suggestions made for women younger than 21 and those older than 65, with all guidelines stating against routine screening, with the exceptions of CTFPHC and CCA that expand the age group to up to 70 and 75 years, respectively. Continuation of screening in older women is also suggested in those with a history of a precancerous lesion and those with inadequate screening. Most guidelines recommend routine screening at 30–65 years, while the WHO advises that screening should be prioritized at 30–49 years. HPV DNA testing is the method of choice recommended by most guidelines, followed by cytology as an alternative, except for CTFPHC, which refers to cytology only, with self-sampling being an acceptable method by most medical societies. Agreements exist regarding recommendations for specific groups, such as women with a history of total hysterectomy for benign reasons, women with a complete vaccination against HPV, individuals from the lesbian, gay, bisexual, transgender, and queer communities and women with multiple sexual partners or early initiation of sexual activity. On the other hand, the age group of 21–29 is addressed differently by the reviewed guidelines, while differentiations also occur in the screening strategies in cases of abnormal screening results, in women with immunodeficiency, those with in utero exposure to diethylstilbestrole and pregnant women. The development of consistent practice protocols for the most appropriate cervical cancer screening programs seems to be of major importance to reduce mortality rates and safely guide everyday clinical practice. Full article

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

The goal of gender-affirming hormone therapy (GAHT) is to align an individual’s physical characteristics with their gender identity by suppressing endogenous sex hormones and replacing them with those consistent with their gender. Transgender women undergoing GAHT are at higher risk of cardiovascular complications, and since clinical evidence suggests that hypertension is associated with increased bone loss, we investigated the effects of estrogen treatment on bone health in a hypertensive transgender animal model. Male spontaneously hypertensive rats were orchiectomized (Orch), and half of them received estrogen treatment (Orch + Es), while a third group remained intact as controls. Bone marrow progenitor cells (BMPCs) were isolated to assess osteogenic potential, and femurs were collected for histological and mechanical analysis. BMPCs from Orch + Es rats exhibited enhanced osteogenic potential compared to those from Orch rats. Histological analysis revealed a higher number of osteocytes and fewer adipocytes in the Orch + Es group. Mechanical testing showed reduced bone strength in Orch rats, which was partially preserved in Orch + Es animals. In conclusion, estrogen administration mitigated the deleterious effects of testosterone depletion on BMPCs and provided protective effects on bone structure and strength in this preclinical model of GAHT in hypertensive rats. Full article

Background: Brazil’s Unified Health System (Sistema Único de Saúde—SUS) has played a crucial role in reducing health disparities by providing universal and free healthcare to a diverse population. However, the COVID-19 pandemic exposed significant barriers to healthcare access among vulnerable groups, particularly due to the intersection of multiple vulnerabilities. This study aimed to examine how intersectionality—specifically sex/gender, race/ethnicity, and education level—has influenced inequalities in healthcare service utilization among vulnerable populations during the COVID-19 pandemic in Brazil. Methods: This cross-sectional study is part of the “COVID-19 Social Thermometer in Brazil” project, conducted between May 2022 and October 2023 in Brazil’s state capitals and the Federal District, focusing on populations considered socially vulnerable during the pandemic. Participants were selected using sequential sampling and completed a structured questionnaire. Statistical analyses—performed using Excel, RStudio (version 4.3.2), and ArcGIS—included sociodemographic profiling, the construction of the Jeopardy Index (a measure of social vulnerability), and binary logistic regression to explore associations between Jeopardy Index and healthcare service utilization. Results: 3406 participants, the majority were men (60%), aged 30 to 59 years (65.1%), and identified as Black or Brown (72.2%). Most participants were concentrated in the Northeast (26.6%) and North (22.3%) macroregions. A high reliance on public healthcare services (SUS) was observed, particularly in the Southeast (96%). According to the Jeopardy Index, the most socially vulnerable groups—such as women, transgender individuals, Black people, and those with no formal education—were significantly more likely to rely on SUS (OR = 3.14; 95% CI: 1.34–7.35) and less likely to use private healthcare (OR = 0.07; 95% CI: 0.02–0.20), reflecting a 214% higher likelihood of SUS use and a 93% lower likelihood of private service utilization compared to the most privileged group. Conclusions: Our findings reveal that individuals experiencing intersecting social vulnerabilities face marked inequalities in healthcare access. Without SUS, these populations would likely have been excluded from essential care. Strengthening SUS and implementing inclusive public policies are critical to reducing disparities and ensuring equitable healthcare access for historically marginalized groups. Full article