Gender minority stress and access to health care services among transgender women and transfeminine people: results from a cross-sectional study in China

Sha, Yongjie; Dong, Willa; Tang, Weiming; Zheng, Lingling; Huang, Xi; Muessig, Kathryn E.; Tucker, Joseph D.

doi:10.1186/s12879-021-06782-5

Cited by 12 publications

(5 citation statements)

References 42 publications

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“…In fact, India stands as the sole country in this review with any evidence of publicly-funded access to GAS [ 59 ]. Given the disadvantaged economic status of TGNB individuals in LMICs, the expenses associated with GAS may pose a particularly significant barrier for this population [ 60 , 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

Shah,

Hassan,

Hassan

et al. 2024

JCM

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Objectives: Fewer than one-fifth of all studies on gender-affirming care originate from low- and middle-income countries (LMICs). This is the first systematic review to examine surgical demographics and outcomes following gender-affirming surgery (GAS) in LMICs. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were systematically searched for original studies and case series on GAS within LMIC settings. Excluded reports included animal studies, non-English language studies, secondary studies including reviews, individual case reports and conference abstracts. Results: This review includes 34 studies involving n = 5064 TGNB individuals. Most studies (22, 64.7%) were from upper-middle-income countries, followed by lower-middle-income countries (12, 35.3%). A total of 31 studies (91.2%) reported on post-operative outcomes. Of n = 5013 patients who underwent GAS, 71.5% (n = 3584) underwent masculinizing and 29.5% (n = 1480) underwent feminizing procedures. The predominant procedures were metoidioplasty (n = 2270/3584, 63.3%) and vaginoplasty (n = 1103/1480, 74.5%). Mean follow-up was 47.7 months. In patients who underwent metoidioplasty, 6.8% (n = 155) of patients experienced a complication and 6.3% (n = 144) underwent revision surgery. In patients who underwent vaginoplasty, 11.5% (n = 127) of patients experienced a complication and 8.5% (n = 94) underwent revision surgery. Of the studies (25/34, 73.5%) that reported on quality of life and post-operative satisfaction, the majority showed marked improvements in psychosocial and functional outcomes. Notably, no post-surgical regret was reported among the surveyed patients. Conclusions: Existing literature on GAS in LMICs remains scarce and is concentrated in select institutions that drive specific procedures. Our review highlights the low reported volumes of GAS, variability in surgical outcomes and quality of life.

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Section: Discussionmentioning

confidence: 99%

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

Shah,

Hassan,

Hassan

et al. 2024

JCM

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“…The minority stress model has been used extensively in various settings. For instance, it has been utilized to assess how minority stress affects the access to health services in transgender and transfeminine Chinese people (Sha et al, 2021); how discriminatory public policy affects the health, depression, and well‐being of Indian sexual and gender minorities (Rao & Mason, 2018) the lived experiences around the stress of Indonesian HIV‐positive MSM—how it is influenced by stigma, outness to and acceptance of family, and support from peers (Victoryna et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“You can't thrive when you are being suffocated”: Quantitative and qualitative findings on minority stress in Kenyan queer womxn and trans men

Haase

Zweigenthal

Müller

2023

Sexuality Gender & Policy

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Minority stress can negatively affect sexual and gender minorities' health and well‐being. Little is known about how the factors associated with minority stress influence the lived experiences of sexual and gender minorities in settings where stigma and discrimination are highly prevalent, and the legal context is restrictive. We conducted an online survey among 335 Kenyan queer womxn and trans men collecting data on internalized homophobia, outness, and LGBT shame and pride and supplemented these with 33 interviews among three stakeholder groups. We found that our sample showed overall lower levels of outness, higher levels of shame, and higher levels of internalized homophobia compared to sexual and gender minorities in other studies. Our qualitative data showed that queer womxn and trans men lack a sense of belonging and frequently face violence from various perpetrators. Understanding how minority stress affects the lived experiences of queer womxn and trans men in any context is important to advance mental health and well‐being; it is even more crucial in contexts that restrict the thriving of minorities through legislation, religion, and culture. Advancing the knowledge on minority stress is essential to address the challenges minorities face in these settings.

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“…Despite its effectiveness in reducing the risk of HIV transmission, the supply and population coverage of PrEP may be affected by social determinants of health [ 16 ], such as socioeconomic and demographic factors that negatively impact access to health services [ 17 , 18 ]. As PrEP was initially prioritized for vulnerable populations, considered to be at higher risk for STI, and who historically suffer from marginalization and stigma, these factors may represent structural barriers to accessing PrEP, reducing access and adherence and, consequently, thwarting the main objective of this intervention to reduce the risk of infection [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators

Mendonça Gil,

Conrado,

Nascimento

et al. 2023

PLoS Negl Trop Dis

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Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018–2022), starting from the year of initiation of PrEP administration in Brazilian state capitals. Principal findings Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income. Significance Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

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Gender minority stress and access to health care services among transgender women and transfeminine people: results from a cross-sectional study in China

Cited by 12 publications

References 42 publications

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

“You can't thrive when you are being suffocated”: Quantitative and qualitative findings on minority stress in Kenyan queer womxn and trans men

HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators

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