Decision Support Needs for Transgender and Gender-Diverse Youth and Families: A Patient-Centered Needs Assessment.

PURPOSE: Due to the intertwining of medical and social decision-making, new approaches to shared decision-making are likely needed for supporting decisions related to the care of transgender and gender-diverse (TGD) adolescents. Prior to developing decision support interventions for TGD youth, a decision support needs assessment must be completed. METHODS: Self-identified TGD youth, family members of TGD youth, clinicians caring for this population, and community advocates participated in one of six group level assessments (GLAs). GLA is a structured, participatory qualitative method that engages diverse groups of stakeholders in generating and evaluating ideas on the topic of interest. Upon completion of all GLAs, a survey was developed and distributed to GLA participants inviting them to rank ideas generated during the GLAs. RESULTS: Six major themes emerged from the GLAs regarding decision support needs, including: improving healthcare provider skills and education, increasing access to support outside the healthcare system, strengthening community and societal support, developing special information resources, supporting youth in leading decision-making about transition, and modifying the healthcare system. In the follow-up survey, improving healthcare provider skills and education was the most commonly chosen top priority. DISCUSSION: Participants identified decision support needs for TGD youth and their families that were mostly distinct from traditional decision support approaches. Participants' focus on the need to improve healthcare provider skills and education provides an opportunity to couple gender-focused education with shared decision-making skills, an approach that may be more sustainable than tools for specific decisions.

Transgender Youths' Perspectives on Telehealth for Delivery of Gender-Affirming Care.

PURPOSE: We aimed to examine transgender youths' interest in receiving gender-affirming care via telemedicine or through primary care with telehealth support. METHODS: We surveyed 12- to 26-year-old transgender youth receiving care in a multidisciplinary gender clinic. Descriptive statistics and bivariate analyses were used to assess relationships between demographic and gender-related characteristics and interest in receiving care via telemedicine. RESULTS: Almost half (47%) of the 204 youth surveyed expressed interest in receiving gender care via telemedicine. Additionally, youth with lower levels of perceived parental support were more likely to express an interest in utilizing telemedicine (p = .001). Approximately half (45%) of youth were interested in receiving gender care in the primary care setting, with a majority expressing willingness to do so if their primary care provider had telehealth support. CONCLUSIONS: Many transgender youth expressed interest in receiving gender care via telehealth, particularly for ongoing care and monitoring. Increased interest in telemedicine was seen among youth with lower perceived parental support.

Oral HIV Self-Implemented Testing: Performance Fidelity Among African American MSM.

Oral-Self Implemented HIV Testing (Oral-SIT) offers a low-cost way to extend the reach of HIV testing systems. It is unclear, however, if high risk populations are able to perform the test with high fidelity. Using a simulation-based research design, we administered desensitized Oral-SIT kits to African American MSM (AAMSM; 17-24 years, N = 178). Participants were HIV negative or never tested, and had never self-administered an Oral-SIT kit. We assessed performance fidelity, and hypothesized antecedents. High levels of social stigma were associated with lower levels of training knowledge (Range = No Errors: 51.9%, 4 Errors: 0.6%) and performance fidelity (Range = No Errors: 39.9%, 3 Errors: 1.7%). Training knowledge and prior testing history were positively associated with performance fidelity. The present work extends research on HIV-related social stigma and suggests that social stigma inhibits knowledge acquisition and task performance. The Oral-SIT training materials were understood by individuals with a wide-range of educational backgrounds. Interventions are needed, however, to further improve Oral-SIT performance fidelity.

The object of sexual desire: examining the "what" in "what do you desire?".

INTRODUCTION: Over the past two decades, sexual desire and desire discrepancy have become more frequently studied as have potential pharmaceutical interventions to treat low sexual desire. However, the complexities of sexual desire-including what exactly is desired-remain poorly understood. AIMS: To understand the object of men's and women's sexual desire, evaluate gender differences and similarities in the object of desire, and examine the impact of object of desire discrepancies on overall desire for partner in men and women in the context of long-term relationships. METHODS: A total of 406 individuals, 203 men and 203 women in a relationship with one another, completed an online survey on sexual desire. MAIN OUTCOME MEASURES: Reports of the object of sexual desire in addition to measures of sexual desire for current partner were collected from both members of the couple. RESULTS: There were significant gender differences in the object of sexual desire. Men were significantly more likely to endorse desire for sexual release, orgasm, and pleasing their partner than were women. Women were significantly more likely to endorse desire for intimacy, emotional closeness, love, and feeling sexually desirable than men. Discrepancies within the couple with regard to object of desire were related to their level of sexual desire for partner, accounting for 17% of variance in men's desire and 37% of variance in women's desire. CONCLUSIONS: This research provides insights into the conceptualization of sexual desire in long-term relationships and the multifaceted nature of sexual desire that may aid in more focused ways to maintain desire over long-term relationships. Future research on the utility of this perspective of sexual desire and implications for clinicians working with couples struggling with low sexual desire in their relationships is discussed.

Patterns and determinants of patient-delivered therapy uptake among healthcare consumers.

BACKGROUND: Patient-delivered partner therapy (PDPT) may be an effective alternative to traditional approaches to sexually transmitted infection control and prevention. Consumer PDPT uptake is comprised of two behaviors: (1) patient willingness to deliver medicine (patient-delivery) and (2) partner willingness to take it (partner-use). METHODS: 505 participants aged 18 to 47 completed a nationally distributed survey of intentions, attitudes, perceived norms, perceived control, and specific outcome beliefs, normative influences, and barriers/facilitators related to PDPT. Zero-order correlations and multivariate statistics were used to describe PDPT uptake patterns and determinants. RESULTS: Consumer uptake exhibited a highly polarized response pattern with the majority willing to participate in patient-delivery (83%) or partner-use (69.4%). Psychosocial determinants of uptake varied by behavior. Regression models of the psychosocial variables (Adj. R>.75) indicate that, across behaviors, PDPT uptake was most closely associated with perceived norm, followed by attitude and perceived control. Specific factors related to uptake include: beliefs that PDPT makes curing disease easier, reduces the spread of the disease, and ensures people are cured; recommendation by healthcare providers; and that the medicine comes with a note from the healthcare provider and is sealed. Several participant characteristics were also significantly correlated with uptake. CONCLUSIONS: Consumers are willing to engage in PDPT and perceive delivery and use differently. Several beliefs and participant characteristics emerged as potentially important factors in willingness to participate. This information can inform the passage of enabling legislation; the selection of PDPT participants; and the development of provider, patient, and partner informational materials.

Vaginal lactobacilli in adolescents: presence and relationship to local and systemic immunity, and to bacterial vaginosis.

OBJECTIVE: The objective of this study was to survey middle adolescents for the presence of vaginal lactobacilli, lactobacilli-specific immune sensitization, and correlates of vaginal immunity with lactobacilli and bacterial vaginosis (BV). METHODS: A cohort of 89 female adolescents were evaluated for the presence of vaginal lactobacilli species, H2O2-producing species, and the prevalence of BV. Cytokines and antibodies in cervicovaginal lavages were detected and peripheral blood lymphocyte (PBL) responses to Lactobacillus crispatus were evaluated. RESULTS: The majority of lactobacillus species were H2O2-producing and predominated by Lactobacillus acidophilus. PBL responses to lactobacilli were detectable in 50% of the cohort. BV was present in 36% of adolescents and negatively correlated with the presence of vaginal lactobacilli. The majority of locally associated cytokines and antibodies were similar in those with or without BV or lactobacilli. CONCLUSIONS: Adolescents harbor vaginal lactobacilli with relationships to BV along with lactobacilli-specific immune sensitization, but with few correlates of local immunity to lactobacilli or BV.

Older partners not associated with recurrence among female teenagers infected with Chlamydia trachomatis.

BACKGROUND: Chlamydia trachomatis-infected female teenagers with older partners may be less likely to discuss the infection with their partner(s) and to use condoms and therefore may be more likely to get reinfected. GOAL: To determine if C trachomatis-infected female teenagers with older partners were more likely to be reinfected than those with same-aged partners. STUDY DESIGN: Females aged 14 years to 18 years who had uncomplicated chlamydial infection, were nonpregnant, attended clinics in five United States cities from June 1995 to May 1997, completed treatment, and resumed sexual activity were observed at 1 and 4 months for interim history and retesting. RESULTS: Of 225 women studied, 73.3% were black, 34.5% had at least one partner who was 3 or more years older during follow-up, 51.6% reported using a condom at the last sex act with all partners, 13.8% had a recurrent infection, and 47.4% reported they were certain that all of their baseline partners were treated. Partner age was not associated with condom use, certainty of partners' taking medication, or recurrent infections after adjustment for visit. CONCLUSIONS: Older partners, accounting for approximately one third of all partners, did not increase the risk of reinfection. Given the high risk for recurrence, follow-up testing and enhanced efforts to ensure partner treatment are appropriate for all young women with chlamydial infections.