Kristi E. Gamarel

From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.

This study examined potential facilitators and barriers to pre-exposure prophylaxis (PrEP) use and their association with PrEP acceptability and motivations for adherence among 184 MSM and transgender women living in New York City. Participants were presented with educational information about PrEP and completed a computerized survey. Overall, 55.4% of participants reported willingness to take PrEP. The most highly endorsed barriers to PrEP use were health concerns, including both long-term impacts and short-term side effects, questions about PrEPs impact on future drug resistance, and concerns that PrEP does not provide complete protection against HIV. The most highly endorsed facilitator was free access to PrEP, followed by access to support services such as regular HIV testing, sexual health care/monitoring, and access to one-on-one counseling. Participants of color rated both barriers and facilitators as more important than their White counterparts. In multivariate models, barrier and facilitator scores significantly predicted not only PrEP acceptability, but also motivation for PrEP adherence among those who were likely to use PrEP. PrEP implementation programs should consider addressing these barriers and facilitators in protocol and policy development. Findings underscore the importance of support services, such as sexual health counseling, to the success of PrEP as a prevention strategy.

Gender minority stress, mental health, and relationship quality: A dyadic investigation of transgender women and their cisgender male partners

Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on ones romantic affiliation) were associated with both partners relationship quality and mental health. Couples (n = 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor-partner interdependence models were conducted to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partners higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partners greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.

Intimacy Motivations and Pre-exposure Prophylaxis (PrEP) Adoption Intentions Among HIV-Negative Men Who Have Sex with Men (MSM) in Romantic Relationships

BackgroundIn the USA, men who have sex with men (MSM) in primary partnerships are at elevated risk for human immunodeficiency virus (HIV) infection. Pre-exposure prophylaxis (PrEP), a new biomedical prevention strategy, has potential to reduce HIV transmission. This study examined predictors of PrEP adoption intentions among HIV-negative MSM in primary partnerships.MethodsThe sample included HIV-negative MSM (n = 164) who participated in an ongoing cross-sectional study with an in-person interview examining PrEP adoption intentions.ResultsHigher HIV risk perception, intimacy motivations for condomless sex, recent condomless anal sex with outside partners, education, and age were each independently associated with PrEP adoption intentions. In a multivariate model, only age, education, and intimacy motivations for condomless sex were significantly associated with PrEP adoption intentions.ConclusionsIntimacy motivations may play a central role in PrEP adoption for MSM couples. Incorporating relationship dynamics into biomedical strategies is a promising avenue for research and intervention.

Female-to-male transmasculine adult health: a mixed-methods community-based needs assessment.

BACKGROUND: There is a dearth of health research about transgender people. OBJECTIVES: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. DESIGN: A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. RESULTS: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. CONCLUSIONS: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

OBJECTIVES We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States. METHODS We analyzed data from 11,114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults. RESULTS After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use. CONCLUSIONS Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.

Association Between Socioeconomic Position Discrimination and Psychological Distress: Findings From a Community-Based Sample of Gay and Bisexual Men in New York City

OBJECTIVES We examined the association between discrimination and mental health distress, focusing specifically on the relative importance of discrimination because of particular demographic domains (i.e., race/ethnicity, socioeconomic position [SEP]). METHODS The research team surveyed a sample of gay and bisexual men (n = 294) at a community event in New York City. Participants completed a survey on demographics, discrimination experiences in the past 12 months, attributed domains of discrimination, and mental health distress. RESULTS In adjusted models, discrimination was associated with higher depressive (B = 0.31; P < .01) and anxious (B = 0.29; P < .01) symptoms. A statistically significant quadratic term (discrimination-squared; P < .01) fit both models, such that moderate levels of discrimination were most robustly associated with poorer mental health. Discrimination because of SEP was associated with higher discrimination scores and was predictive of higher depressive (B = 0.22; P < .01) and anxious (B = 0.50; P < .01) symptoms. No other statistically significant relationship was found between discrimination domains and distress. CONCLUSIONS In this sample, SEP emerged as the most important domain of discrimination in its association with mental health distress. Future research should consider intersecting domains of discrimination to better understand social disparities in mental health.

A compensatory model of risk and resilience applied to adolescent sexual orientation disparities in nonsuicidal self-injury and suicide attempts.

This study investigated and applied a compensatory model of risk and resilience to differences in past-year nonsuicidal self-injury (NSSI) and suicide attempts by sexual orientation using representative data from the 2007 Massachusetts Youth Risk Behavior Survey (n = 3,131). Self-identified lesbian, gay, bisexual, and questioning (LGBQ) adolescents comprised 7% of the sample, but accounted for 67% of NSSI and 80% of suicide attempts. Compared with heterosexuals, LGBQ adolescents had an increased odds of NSSI (adjusted Odds Ratio (aOR) = 2.76; 95% Confidence Interval (CI) [2.00, 3.81] and suicide attempts (aOR = 2.73; 95% CI [1.47, 5.08]. NSSI was highly associated with suicidality (aOR = 10.87; 95% CI [6.17, 19.18]. Family support was independently associated with a decreased odds of both NSSI (aOR = 0.56; 95% CI [0.35, 0.89] and suicidality (aOR = 0.48; 95% CI [0.29, 0.79] supporting a compensatory model of resilience. Screening and preventive interventions for LGBQ adolescents are warranted, including at the family level. Sexual orientation should be included as a standard demographic to monitor health disparities.

Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults.

PURPOSE Enacted and anticipated stigma exist within healthcare settings for transgender people, but research has yet to examine the effects of these forms of stigma on the substance use behaviors of female-to-male (FTM) trans masculine people. METHODS Data were analyzed from the cross-sectional U.S. National Transgender Discrimination Survey, a convenience sample of transgender adults purposively sampled in 2008. Trans masculine respondents (n=2,578) were identified using a two-step method: Step 1, Assigned birth sex; Step 2, Current gender identity. A gender minority stress model of substance use was tested to examine the relation of enacted and anticipated stigma with substance use to cope with mistreatment. RESULTS Overall, 14.1% of the sample reported having been refused care by a provider (enacted stigma), 32.8% reported delaying needed medical care when sick/injured, and 39.1% delayed routine preventive care (anticipated stigma). Having been refused care was significantly associated with avoidance of healthcare, including delaying needed medical care when sick/injured and delaying routine preventive medical care. Substance use to cope with mistreatment was self-reported by 27.6% of the sample. Enacted stigma by providers was associated with self-reported substance use to cope. Delays in both needed and preventive care (anticipated stigma) were highly associated with substance use, and attenuated the effect of enacted stigma. CONCLUSION Gender minority-related stressors, particularly enacted and anticipated stigma in healthcare, should be integrated into substance use and abuse prevention and intervention efforts with this underserved population.

Identity Safety and Relational Health in Youth Spaces: A Needs Assessment with LGBTQ Youth of Color

This article focuses on the function of youth organizations for lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities of color. LGBTQ young people (N = 29) participated in a series of focus groups, completed a brief demographic survey, and created individual community maps. The youth organization was described as providing LGBTQ youth with a home and sense of “we,” which provided support for developing a sense of authenticity, mutual engagement, conflict tolerance, and empowerment in the face of discrimination. This study documents current forms of intervention occurring within the organization, particularly in providing an identity-safe environment to promote relational health. Findings support recommendations to foster resilience and positive identity development for LGBTQ youth of color.

Minority Stress, Smoking Patterns, and Cessation Attempts: Findings From a Community-Sample of Transgender Women in the San Francisco Bay Area.

INTRODUCTION Research has demonstrated associations between reports of minority stressors and smoking behaviors among lesbian, gay, and bisexual populations; however, little is known about how minority stressors are related to smoking behaviors and cessation attempts among transgender women. The purpose of this study was twofold: (1) to examine the associations between transgender-based discrimination and smoking patterns among a sample of transgender women; and (2) to identify barriers to smoking cessation in a sample of transgender women with a history of smoking. METHODS A community sample of 241 transgender women completed a one-time survey. Binary and multinomial logistic regression models examined associations between minority stressors and (1) smoking behaviors and (2) cessation attempts. Both models adjusted for income, education, race/ethnicity, recent sex work, HIV status, depression, alcohol use, and current hormone use. RESULTS Overall, 83% of participants indicated that they had smoked a cigarette in the last month. Of these women, 62.3% reported daily smoking and 51.7% reported an unsuccessful quit attempt. Discrimination was positively associated with currently smoking (adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI]: 1.01, 1.08). Discrimination was positively associated with unsuccessful cessation (AOR = 1.03, 95% CI: 1.01, 1.18) and never attempting (AOR = 1.04, 95% CI: 1.01, 1.11) compared to successful cessation. Discrimination was also positively associated with never attempting compared to unsuccessful cessation (AOR = 1.01, 95% CI: 1.00, 1.03). CONCLUSIONS Smoking cessation may be driven by unique transgender-related minority stressors, such as discrimination. Future research is warranted to address unique stigmatizing contexts when understanding and providing tailored intervention addressing smoking among transgender women.