Matchmaking Methodology for Humanizing Transgender and Gender Diverse Health Research.

BACKGROUND: Current research on transgender and gender diverse (TGD) health focuses on a damage-centered approach to health outcomes, often further marginalizing and othering TGD individuals and their experiences. The Matchmaking Methodology is an approach that can be used to depathologizes and demedicalizes the TGD experience within research by decentering the cisgender gaze of TGD health research. OBJECTIVES: This article aims to provide researchers a humanizing approach to TGD health and wellness research by outlining the process of the matchmaking methodology that connects individuals to co-create research and knowledge from multiple standpoints-those of scholar, practitioner, and community member. METHODS: Shaped by an approach to co-editing a book on TGD health and social service best practices, the Matchmaking Methodology can be applied to research projects as an intentionally engage method that allows for the centering of TGD voices, the integration of practitioner expertise as well as that of academic scholars with community members through collaborative partnership to conduct and disseminate research. CONCLUSIONS: The matchmaking methodology for TGD health research can address some of the harmful and dehumanizing aspects that have historically dominated TGD-focused research. This approach focuses on the empowerment and critical consciousness of those participating in the collaborative partnership and centers their accountability to TGD individuals. Further, the involvement of practitioners and community members in the research process can translate to research that has a focus on real-life application and impact on best practices, interventions, and policy change.

Identity Matters: Religious Experiences of US based Transgender Young People.

Research centered on the socioemotional benefits of religion and religious congregations for young people has highlighted largely positive outcomes for both young people and religious congregations. However, fewer studies have explored whether transgender young people receive those same socioemotional benefits from being religiously affiliated. Using secondary quantitative data from the 2015 US Transgender Survey, this study examined the religious experiences of transgender young people (aged 18-24). The data indicate that individual demographics (e.g., race, gender identity, sexual orientation, religious affiliation) affected the religious experiences of transgender young people, including leaving their congregations due to the fear of being rejected. More research is needed on the socioemotional benefits of religious affiliation for transgender young people.

"We Are Doing the Absolute Most That We Can, and No One Is Listening": Barriers and Facilitators to Health Literacy within Transgender and Nonbinary Communities.

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes.

Stalking Victimization in LGBTQ Adults: A Brief Report.

Stalking is often considered to be a form of interpersonal violence; yet, despite an increase in lesbian, gay, bisexual, transgender, and queer (LGBTQ)-specific research on other forms of interpersonal violence, such as intimate partner violence and sexual assault, there is a relative lack of literature on stalking victimization of LGBTQ individuals, particularly as it relates to gender identity. This is problematic given the results of numerous studies indicating LGBTQ individuals, and transgender individuals in particular, experience victimization in various forms and contexts at alarming rates. In the current study, we examined secondary data to determine the prevalence of lifetime stalking victimization and subsequent police reporting in a large community-based sample of LGBTQ individuals living in Colorado (N = 1,116). In addition, using chi-square analyses, we examined independence of stalking experiences and police reporting by both gender identity (transgender, cisgender male, cisgender female) and sexual orientation (gay, lesbian, bisexual, heterosexual, queer, other). Approximately 15% of the total sample reported ever experiencing stalking; yet, only about one quarter of those who were stalked reported it to police. Although no statistically significant differences emerged by gender identity or sexual orientation, transgender, bisexual, and queer participants had the highest prevalence of lifetime stalking victimization. Moreover, these groups reported the lowest prevalence of reporting their victimization to the police. We provide suggestions to improve the development of research on this topic including a need for an inclusive definition of stalking and studies using larger, representative samples to better discern potential significant differences in stalking experiences of LGBTQ persons.

One size does not fit all: differential transgender health experiences.

Transgender and nonbinary (TNB) adults face a multitude of challenges when attempting to access general health care. Issues include fear of discrimination and encounters with providers who are not familiar with treating the needs of this population. These challenges may result in the delay or denial of medically necessary care. This study explores nuanced experiences of gender identity and sexual orientation around accessing health care. Using a statewide sample of TNB individuals (N = 417), analyses include descriptive statistics and logistic regressions predicting delayed care due to fear of discrimination and having any medical intervention to understand the importance of transgender-inclusive care and other experiences across identities. Findings indicate differential experiences across gender identity, sexual orientation, and age. Access to a trans-inclusive primary care provider was one of the strongest indicators both for not delaying care due to fear of discrimination and having had a medical intervention. Providers should be provided with more nuanced training about being culturally responsive and aware of differences across sexual orientation within the TNB community. This will move toward ensuring not only increased access to needed care and medical interventions, but toward potentially lowering the rate of those who delay access to care due to fear of discrimination.

Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth.

PURPOSE: Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. METHODS: This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. RESULTS: Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. CONCLUSIONS: LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.

Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender Nonconforming Individuals by (Dis)Ability.

Transgender and gender nonconforming (GNC) individuals frequently experience discrimination and potentially a lack of respect from service providers, suggesting they have decreased access to professionals with cultural competency. Similarly, people with disabilities experience higher levels of discrimination in social services than their nondisabled counterparts. From an intersectional perspective, this study examines rates of discrimination in accessing social services faced by transgender and GNC people, comparing across ability. Data indicate that although transgender and GNC individuals of all abilities experience gender-based discrimination when accessing social services, those with disabilities experience higher levels of antitransgender discrimination in mental health centers, rape crisis centers, and domestic violence shelters.

Grindr, Scruff, and on the Hunt: Predictors of Condomless Anal Sex, Internet Use, and Mobile Application Use Among Men Who Have Sex With Men.

In 2016, gay, bisexual, and other men who have sex with men (MSM) comprise more than half of all new HIV diagnoses in the United States, with the primary mode of infection being condomless anal sex (CAS). While studies report an association between use of Internet-based social networking sites and increased CAS, the research on the relationship between cell phone mobile applications (e.g., Grindr, Scruff, Jack'd) and CAS is much less developed. The present study examines whether the manner in which gay, bisexual, and other MSM find sexual partners predicts an increase in likelihood of engaging in CAS in an urban, noncoastal U.S. city. Conducting a secondary data analysis of the 2011 National HIV Behavioral Surveillance survey for Denver ( N = 546), the authors performed binary logistic regression analyses to assess the models that predict how MSM find sexual partners, and the odds of engaging in CAS. While the results suggest that age and race are associated with the mode of finding sexual partners, using the Internet or a mobile app to find sexual partners was not predictive of CAS ( ZWald = .41, p = .52; ZWald = .80, p = .37). In terms of HIV prevention, these findings suggest a need for intervention to address HIV prevention on multiple levels (e.g., individual, group, community).

Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people.

Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.

Sexual Victimization and Subsequent Police Reporting by Gender Identity Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults.

Prevalence of sexual victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons is frequently found to be higher than the prevalence reported by their heterosexual peers. Transgender individuals are often included solely as part of larger LGBTQ research samples, potentially obfuscating differences between sexual orientation and gender identity. In this study, the authors examined sexual assault/rape in a large convenience sample of LGBTQ adults (N = 1,124) by respondents' gender identity (cisgender, transgender) to determine whether differences exist in lifetime prevalence of sexual assault/rape and subsequent police reporting. Findings indicate transgender individuals report having experienced sexual assault/rape more than twice as frequently as cisgender LGBQ individuals. Authors found no statistically significant difference in reporting sexual violence to police. Implications for research and practice are discussed.

Experiences of Intimate Partner Violence and Subsequent Police Reporting Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults in Colorado: Comparing Rates of Cisgender and Transgender Victimization.

Research indicates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at high risk of victimization by others and that transgender individuals may be at even higher risk than their cisgender LGBQ peers. In examining partner violence in particular, extant literature suggests that LGBTQ individuals are at equal or higher risk of partner violence victimization compared with their heterosexual peers. As opposed to sexual orientation, there is little research on gender identity and partner violence within the LGBTQ literature. In the current study, the authors investigated intimate partner violence (IPV) in a large sample of LGBTQ adults (N = 1,139) to determine lifetime prevalence and police reporting in both cisgender and transgender individuals. Results show that more than one fifth of all participants ever experienced partner violence, with transgender participants demonstrating significantly higher rates than their cisgender peers. Implications focus on the use of inclusive language as well as future research and practice with LGBTQ IPV victims.

Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver, Colorado.

As part of the National HIV Behavioral Surveillance System among men who have sex with men (MSM) in Denver, Colorado, we assessed knowledge of pre-exposure prophylaxis (PrEP); willingness to use PrEP; and potential changes in risk behaviors among HIV-negative participants reporting sexual activity with a male partner in the preceding 12 months. We examined knowledge of PrEP before (2008) and after (2011) results of the iPrEx trial were available. Of the 425 participants in the 2008 sample, 91 (21 %) were aware of PrEP compared to 131 (28 %) of the 461 participants in the 2011 sample (adjusted prevalence ratio: 1.43, 95 % confidence interval: 1.18, 1.72). Despite the increase in 2011, few MSM in Denver were aware of PrEP. Educating high-risk MSM about the potential utility of PrEP as an adjunct to other effective prevention methods is needed when considering the addition of PrEP to the HIV prevention arsenal.

Correlates of engaging in survival sex among homeless youth and young adults.

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium™, crack cocaine, alcohol, Coricidin™, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.

Toward a multidimensional understanding of heterosexism: the changing nature of prejudice.

Extending the theoretical understanding of modern prejudice into the realm of heterosexism, it is argued that shifts in the manifestation of prejudice against lesbians and gay men have occurred resulting in an increasingly multidimensional modern heterosexism. Four subdomains of modern heterosexism are identified that are conceptually and empirical distinct from the more traditional hostile heterosexism: aversive heterosexism, amnestic heterosexism, paternalistic heterosexism, and positive stereotypic heterosexism. The Multidimensional Heterosexism Inventory is offered as an instrument to capture the four theorized subdomains of modern heterosexism, and an examination of reliability and validity of the scale is presented.

Suicidal ideation and attempts among sexual minority youths receiving social services.

The increased risk of suicidal ideation and attempts among sexual minority youths have been documented in studies using both convenience samples and representative community samples. However, as most youths do not access social services, these studies do not necessarily represent the sexual minority youths that community-based social workers may encounter in their day-to-day practice. As such, the present study on risk and protective factors related to suicidality surveyed 182 sexual minority youths (14 to 21 years of age) who sought assistance at a community-based social services agency in Denver. Similar to existing literature, the findings suggest that risk factors related to suicidality include hopelessness, methamphetamine use, homelessness, and in-school victimization. However, unlike studies of the general youth population, this study found that African American and male sexual minority youths were not at a lower risk of suicidality than sexual minority youths who were, respectively, white or female. In addition, our findings suggest that the presence of gay-straight alliances in schools may function as a protective resource for sexual minority youths. Implications for social work practice are discussed.