Beatrice “Bean” E. Robinson

Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

ABSTRACT The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.

Fat phobia scale revisited: the short form

OBJECTIVE: To develop a shortened form of the original 50-item fat phobia scale.METHOD: The first factor from the original fat phobia scale—undisciplined, inactive and unappealing—was identified as a potential short form of the scale. A new sample of 255 people completed the original 50-item scale. The reliability of a shortened 14-item version of the scale was tested and compared to that of the full scale using both the new sample and the original sample of 1135 study participants.RESULTS: The fat phobia scale—short form demonstrated excellent reliability in both samples and was strongly correlated with the 50-item scale. Mean and 90th percentile scores are given for both the long and short versions of the scale.CONCLUSION: The shortened fat phobia scale is expected to increase the utility of the measure in a diverse array of research and clinical settings. Future research should focus on developing scale norms for the general population and conducting research on fat phobia in males and among different ethnic groups.

Meta-analysis of the effectiveness of HIV prevention interventions for women

The present study is a meta-analysis of the effectiveness of HIV prevention interventions for women in the USA. Twenty-four articles from 1989-1997 were included. We evaluated five ethnic groupings (All Ethnicities Combined, African-American, White, Hispanic and a Mixed Ethnicity group) over four time periods (post-test, less than two months after the intervention, 2-3 months after the intervention and 6-24 months after the intervention) on three HIV-related sexuality outcome variables (HIV/AIDS knowledge, self-efficacy and sexual risk reduction behaviour). The HIV interventions appear effective at improving knowledge about HIV/AIDS and increasing sexual risk reduction behaviours for all ethnicities examined at all follow-up periods, with one exception. The findings for self-efficacy are less consistent. The interventions were less consistently effective for African-American women, for whom significant improvements in feelings of self-efficacy were only seen six months or longer after the intervention. The present analysis elucidates ethnic differences which may have previously been obscured while demonstrating convincingly that HIV interventions are generally effective for women of many different ethnicities.

Fat phobia: measuring, understanding, and changing anti-fat attitudes.

We examined fat phobia, defined as a pathological fear of fatness, by constructing the Fat Phobia Scale, determining its reliability and validity, examining correlates of fat phobia, and using a treatment approach designed to decrease fat phobia. Study 1 describes the development of the Fat Phobia Scale, a 50-item, modified 5-point semantic differential scale. Subjects (974 females and 117 males) completed the scale; factor analysis yielded six factors. Respondents who are average weight, female, younger, have more than a high school education, or are nonmedical professionals are more likely to have fat phobic attitudes. Study 2 examines fat phobic attitudes of women (N = 40) who had negative feelings about their bodies. Subjects completed the Fat Phobia Scale before and after a treatment approach designed to reduce their feelings of responsibility for fatness. Total scores on the Fat Phobia Scale and scores on all six factors decreased significantly, indicating a decrease in fat phobia.

Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community

Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.

Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships

Gay and bisexual men who indicated they were currently in a primary relationship with another man (N=230) completed measures of HIV treatment attitudes, sexual risk behaviour and sexual sensation seeking. Results indicate non-primary partner sexual activity is common in many gay relationships and men in non-exclusive relationships possessed greater levels of sexual sensation seeking and treatment-related reduced concern about the dangerousness of HIV than men in exclusive relationships. Results also suggest that individuals who were members of HIV-seroconcordant relationships were more likely to engage in unprotected sexual activity with their primary sexual partners than gay men who were members of HIV-discordant couples. A series of regression analyses revealed that reduced concern about HIV mediated the relationship between sexual sensation seeking and sexual risk behaviour. The next generation of HIV prevention interventions must address the attitudinal shifts that have occurred among some gay men regarding the seriousness of HIV and should be sensitive to the dynamics of gay relationships.

Drug Use, Unsafe Sexual Behavior, and Internalized Homonegativity in Men Who Have Sex With Men

Previous research has identified alcohol and drug use as predictive of unsafe sexual behavior among men who have sex with men (MSM). The purpose of this study was to assess whether substances associated with the greatest alteration in consciousness are associated with increased risk behavior, and to explore any relationship between internalized homonegativity and alcohol and other drug use. Participants in the study were 422 Midwestern MSM who volunteered to evaluate a seminar on sexuality and intimacy between men. Alcohol, chemical use, and dependency during the last 2 weeks were assessed using standardized questions and CAGE screening questions. Internalized homonegativity was assessed using the 26-item Reactions to Homosexuality scale. Components of unsafe sexual behavior during the preceding 3 months was assessed using dichotomous variables and collapsed into an overall measure of contextualized risk. Consistent and strong associations (ORs between 2.32 and 4.57) were found between unsafe sexual behavior and alcohol and other drug use. The greater the alcohol problem and the harder the drugs and the more they may impact consciousness or disinhibition, the greater the apparent association with unsafe sex. Degree of alteration of consciousness and disinhibition appear to be the common underlying dimensions of risk, although dose-level data were not available. The data did not support any consistent association between internalized homonegativity and use of drugs and alcohol.

Understanding Sexual Perpetration Against Children: Effects of Attachment Style, Interpersonal Involvement, and Hypersexuality

This study explores in an adolescent sample hypotheses about child sexual abuse perpetration drawn from contemporary theories that implicate insecure attachment and adolescent social development. Specifically, three 13- to 18-year-old adolescent male samples (sex offenders with child victims, sex offenders with peer/adult victims, and nonsex delinquent youth) were compared in a cross-sectional design. Participants completed a computer-administered self-report questionnaire and a semistructured attachment style interview. Attachment style was coded by two independent raters blind to study hypotheses and group membership. The results indicated an indirect effect for attachment style. Attachment anxiety affected involvement with peers and interpersonal adequacy. Feelings of interpersonal inadequacy, combined with oversexualization and positive attitudes toward others distinguished sex offenders with child victims from nonsex delinquents and from sex offenders with peer/adult victims. These data provide a preliminary model of sexual abuse perpetration consistent with contemporary theories. Attachment anxiety with a lack of misanthropic attitudes toward others appears to lead to isolation from peers and feelings of interpersonal inadequacy. Individuals with this constellation of factors may turn to children to meet their intimacy and sexual needs, both of which seem to be exaggerated compared with other troubled youth.

A Systematic Review of Instruments That Measure Attitudes Toward Homosexual Men

Scientific interest in the measurement of homophobia and internalized homophobia has grown over the past 30 years, and new instruments and terms have emerged. To help researchers with the challenging task of identifying appropriate measures for studies in sexual-minority health, we reviewed measures of homophobia published in the academic literature from 1970 to 2012. Instruments that measured attitudes toward male homosexuals/homosexuality or measured homosexuals’ internalized attitudes toward homosexuality were identified using measurement manuals and a systematic review. A total of 23 instruments met criteria for inclusion, and their features were summarized and compared. All 23 instruments met minimal criteria for adequate scale construction, including scale development, sampling, reliability, and evidence of validity. Validity evidence was diverse and was categorized as interaction with gay men, HIV/AIDS variables, mental health, and conservative religious or political beliefs. Homophobia was additionally correlated with authoritarianism and bias, gender ideology, gender differences, and reactions to homosexual stimuli. Internalized homophobia was validated by examining relationships with disclosing ones homosexuality and level of homosexual identity development. We hope this review will make the process of instrument selection more efficient by allowing researchers to easily locate, evaluate, and choose the proper measure based on their research question and population of interest.

Risky sexual behavior in low‐income African American women: The impact of sexual health variables

In a sample of 163 low‐income African American women, we used logistic regression analyses to test for associations between (a) 5 operationalized constructs theorized in the Sexual Health Model to impact ones overall sexual health (barriers to healthy sexuality, sexual anatomy and functioning, positive sexuality, sexual health care, and cultural identity) and (b) several measures of risky sexual behavior (consistent condom use, multiple concurrent partnerships, and overall sexual risk). No significant relationship was found between acculturation and risky sexual behaviors. Having sexual difficulties was positively associated with overall sexual risk and multiple concurrent partnerships. Favorable attitudes toward condoms were positively associated with consistent condom use. Desiring or intending pregnancy was positively associated with inconsistent condom use and overall sexual risk behavior. This is only the second study linking sexual difficulties and risky sexual behavior. The exact nature of this correlational relationship needs to be studied and replicated in different and more heterogeneous populations.