Posttraumatic stress disorder mediating associations between child sexual abuse and substance use among transgender adults in the United States.

Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016-2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny's approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Earlier Sexual Debut and Anti-Gay Victimization Among Men Who Have Sex With Men (MSM) in Kazakhstan.

Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut-categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group-and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences.

Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan.

Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25-3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65-5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88-6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan - highlighting need for intervention efforts targeting the most marginalized groups.

Earlier Sexual Debut and Exchange Sex among Men Who Have Sex with Men (MSM) in Kazakhstan.

Limited research has examined prevalence rates and associations related to exchange sex behaviors among gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan. This study aimed to examine associations between earlier sexual debuts and lifetime exchange sex behaviors among Kazakhstani MSM. Using data from a National Institute on Drug Abuse-funded Human Immunodeficiency Virus (HIV) prevention trial, we conducted a secondary analysis of self-reported data from 766 adult cisgender MSM in Kazakhstan, who completed structured screening interviews. Earlier sexual debuts were measured as age of sexual onset prior to 16 years old with ages 16 and older as the reference group. Logistic regression models were used to estimate associations between earlier sexual debuts and lifetime reports of buying or selling sex for resources, with covariance adjustment for sociodemographic characteristics. The study findings indicated that, among our sample of MSM in Kazakhstan, 23% had sold sex, and 26% had bought sex in their lifetime. Kazakhstani MSM who reported an earlier sexual debut had significantly higher odds of ever selling or buying sex in their lifetime. Future research should examine how consensual and non-consensual sexual activities during childhood and adolescence relate to exchange sex behaviors and risk among MSM.

Increased fetal microchimerism in immune and stem cell subsets in preeclampsia.

PROBLEM: Preeclampsia (PE) is associated with an increased risk of maternal cardiovascular disease (CVD), however, it is unclear whether this is due to shared underlying physiology or changes which occur during the disease process. Fetal microchimerism (FMc) within the maternal circulation can durably persist decades after pregnancy, is known to occur at greater frequency in PE, and can potentially affect local and systemic immune programming, thus changes in cellular FMc may provide a mechanism for long-term health outcomes associated with PE. METHOD OF STUDY: We investigated whether PE is associated with alterations in FMc immune and stem cell populations. We analyzed maternal peripheral blood mononuclear cells (PBMC) from PE cases (n = 16) and matched controls from normal pregnancies (n = 16), from which immune and stem cell subsets were isolated by flow cytometry. Genomic DNA was extracted from total PMBC and individual cell subsets, and FMc frequency was quantified by quantitative polymerase chain reaction assays targeting a fetal-specific non-shared polymorphism identified from family genotyping. RESULTS: There was a significant increase in FMc concentration in immune cell subsets in PE cases compared to controls, predominantly in B cell, and NK cell lymphocyte populations. There was no significant difference in FMc frequency or concentration within the stem cell population between PE and controls. CONCLUSIONS: The altered concentrations of immune cells within FMc in the maternal blood provides a potential mechanism for the inflammation which occurs during PE to induce long-lasting changes to the maternal immune system and may potentially promote chronic maternal disease.

Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan.

This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.