Family Rejection, Socioeconomic Precarity, and Exchanging Sex for Food among Young Transgender Adults: Findings from the U.S. Transgender Survey.

This study explored factors associated with elevated risk of exchanging sex for food in young transgender adults in the U.S. We analyzed data from a sample of trans-gender adults (18-35 years old) who participated in the 2015 U.S. Transgender Survey. Participants were asked if they had engaged in sexual activity for food within the past year or more than a year ago. Welfare participation, family rejection, and experience of homelessness were significantly associated with a higher likelihood of exchanging sex for food. Young transgender adults with multiple marginalized identities, such as identifying as Black or African American, presenting a non-normative gender expression, and living with a disability, were at higher risk of engaging in sex for food. Our study underscores family rejection and socioeconomic precarity, which may erode the social support and safety net of young transgender adults, preventing them from affording and accessing adequate food.

HIV Prevention Services in Residential Substance Use Disorder Treatment Facilities in the United States.

Residential substance use disorder treatment is designed to treat more severe substance use disorders. Considering the strong association between substance use and HIV, providing HIV prevention services during residential substance use disorder treatment is imperative. However, not all treatment facilities offer the same services, and differences in residential substance use disorder treatment facilities providing HIV prevention services might stem from facility-level characteristics. Using 3 years (2018-2020) of cross-sectional data from the National Survey of Substance Abuse Treatment Services, we examined which treatment facility characteristics were associated with having HIV prevention services. Using a logistic regression model with HIV prevention services as the outcome, we found that facilities that were accredited, engaged in community outreach, and offered assistance with housing and transportation were more likely to provide HIV prevention services. Furthermore, facilities in the Midwest and West were less likely to provide HIV prevention services than those in the South.

Evaluating a Tobacco Treatment Program's Transition to Telehealth Using a Social Determinants of Health Lens.

INTRODUCTION: While strong associations exist between social determinants of health (SDOH), socioeconomic status, and smoking, these factors are not routinely assessed in tobacco treatment programs (TTP). This study addresses this gap by evaluating a composite metric of SDOH and a measure of access to care to determine program reach before and after the implementation of telehealth tobacco treatment delivery. AIMS AND METHODS: We examined inpatient data from a large TTP during two comparable time periods from April 1, 2019 to September 30, 2019 (pre-telehealth) and from April 1, 2020 to September 30, 2020 (telehealth). The populations were compared using point-of-care data, including 5-digit zip codes mapped to the CDC's Social Vulnerability Index (SVI) and driving distance (in 60-min increments) to the study hospital. Chi-square tests for homogeneity were performed for SVI and driving distance comparisons. RESULTS: While distance distributions were significantly different between the pre-telehealth and telehealth populations (χ 2 = 13.5 (df = 3, N = 3234), p = .004, no significant differences existed in the proportion of SVI categories between the two populations (χ 2 = 5.8 (df = 3, N = 3234), p = .12). In the telehealth population, patients with the highest SVI vulnerability had the greatest proportions living >1 h from the hospital. CONCLUSIONS: This study offers a novel evaluation of tobacco treatment in relation to an SDOH metric (SVI) and care access (distance to the hospital) for inpatient populations. Patient reach, including to those with high vulnerabilities, remained consistent in a transition to telehealth. These methods can inform future reach and engagement of patients who use tobacco products, including patients with high vulnerability or who reside at greater distances from treatment programs. IMPLICATIONS: This study provides the first analysis of inpatient tobacco use treatment (TUT) transition to telehealth delivery of care during the COVID-19 pandemic using the CDC's SVI metric and patient distance to the hospital. The transition resulted in consistent reach to patients at the highest vulnerability. These findings can inform efforts to evaluate SDOH measures and improve reach, engagement, and research on telehealth delivery of inpatient TUT.

Walking and perceived lack of safety: Correlates and association with health outcomes for people living with HIV in rural Zambia.

Introduction: Geographic inaccessibility disproportionately affects health outcomes of rural populations due to lack of suitable transport, prolonged travel time, and poverty. Rural patients are left with few transport options to travel to a health facility. One common option is to travel by foot, which may present additional challenges, such as perceived lack of safety while transiting. We examined the correlates of perceived lack of safety when walking to a health facility and its association with treatment and psychosocial outcomes among adults living with HIV. Methods: Data were collected from 101 adults living with HIV in Eastern Province, Zambia. All participants were receiving antiretroviral therapy at one of two health clinics. Perceived lack of safety was measured by asking respondents whether they felt unsafe traveling to and from the health facility in which they were receiving their HIV care. Outcomes included medication adherence, perceived stress, hope for the future, and barriers to pill taking. Linear and logistic regression methods were used to examine the correlates of perceived safety and its association with health outcomes. Results: Being older, a woman, having a primary education, living farther from a health facility, traveling longer to reach a health facility, and owing money were associated with higher likelihood of feeling unsafe when traveling by foot to health facility. Perceived lack of safety was associated with medication nonadherence, higher level of stress, lower level of agency, and more barriers to pill taking. Conclusions: Perceived lack of safety when traveling by foot to a health facility may be a barrier to better treatment and psychosocial outcomes, especially among rural patients. Practitioners and policymakers should consider implementation of differentiated HIV service delivery models to reduce frequent travel to health facilities and to alleviate ART patients' worry about lack of safety when traveling by foot to a health facility.

Immigration Policy as a Social Determinant of Health: Development and Initial Validation of a Measure to Assess Attitudes toward Immigrant Integration.

Anti-immigrant policymaking in the U.S. is a critical social determinant of health compromising the wellbeing of immigrants and, by extension, communities of color. It is imperative that social work, public health, and other allied professions unite to address anti-immigrant policymaking by improving intergroup attitudes and building broader public support for immigrant integration. This study fills a gap in the literature by psychometrically developing and initially validating a measure of attitudes toward integrationist immigration policymaking. A three-stage study was conducted to explore, calibrate, and validate the factor structure using exploratory and confirmatory factor analysis. Findings suggest there are two distinct but interrelated dimensions of attitudes toward integrationist immigration policies: support for the (a) extension of pathways to legal status and (b) expansion of eligibility for social rights and benefits. Initial evidence of criterion validity for the scale is offered. The utility of the measure for intergroup intervention testing is discussed.

"Life at the River is a Living Hell:" a qualitative study of trauma, mental health, substance use and HIV risk behavior among female fish traders from the Kafue Flatlands in Zambia.

BACKGROUND: In Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4-14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia. METHODS: Twenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data. RESULTS: The findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population. CONCLUSIONS: The indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia.