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Try out PMC Labs and tell us what you Casual sex in Addis Los Angeles. Learn More. Findings demonstrated that participants in the latter study reported ificantly higher access to healthcare insurance and prescription hormones.

While healthcare access has improved, transgender women continue to face ificant barriers to good health, indicating the need for increased attention to this population. Transgender women face numerous adverse health disparities in comparison to cisgender individuals, including higher rates of substance use; HIV and STI prevalence, incidence and risk behaviors; and, mental health disorders including depression, anxiety and suicidality 1 — 5. Due to structural barriers i.

The cyclical nature of these health disparities is perhaps most evident in the high rates of transgender women who engage in sex work 10 — 13 : forced out of legitimate economies due to discrimination, transgender women often turn to sex work to survive, which in turn puts them at increased risk for HIV and STIs, violence, and incarceration 10 — 12 Health disparities and ificant structural and interpersonal barriers to good health have been well-documented among transgender women; however, no study has investigated how these health disparities and determinants have improved or worsened over time.

Despite these cultural and medical shifts, it is unclear what the impact of these changes, if any, is on the health of transgender communities. A search of longitudinal and comparison studies of transgender health finds that almost all were published after and utilized short-term follow-up or comparison i.

An incomplete understanding of how risk profiles and health outcomes among transgender women have or have not changed over longer periods of time limits the ability of public health professionals to implement targeted interventions focused on high-risk transgender populations. For instance, while there have been extensive efforts in the past decade to increase health research and implement tailored interventions for transgender women 22 — 27the impact of these efforts remains unclear without data from comparison studies across time.

The aim of this investigation was to understand how transgender health disparities in LAC have improved or worsened across multiple over time, so as to better inform health interventions focused on the unmet needs of transgender women. Potential participants were deemed eligible to participate if they were 18 years of age or older; lived in LAC; and identified as a transgender woman or as a woman who was ased the male sex at birth. Given the diversity in transgender populations over the 17 years since Study 1, and the aim to recruit moderate- and high-risk transgender women, the following eligibility was added to Study 2: Use of alcohol any amount or an illicit substance including non-medically prescribed marijuana or unprotected anal intercourse either insertive or receptive in the past 6 months.

The added eligibility criterion was deemed necessary to enroll a similar sample profile in Study 2 as was enrolled in Study 1. Due to the cultural shift in transgender visibility over the 17 year period, without the added eligibility criterion no- and low-risk transgender women could enroll in the study.

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Yet, it was critical to enroll only moderate- and high-risk transgender women to address the aim of the study. Participants in Study 1 were recruited from February to January and participants in Study 2 were recruited from July to September Potential participants for both studies were recruited via street- and venue-based outreach and from collaborating community-based organizations that provided services to transgender women; most of the agencies were consistent between the two studies.

All research assistants identified as a transgender woman four part-time research assistants for Study 1 and two full-time research assistants for Study 2 and were highly trained on non-invasive outreach Casual sex in Addis Los Angeles recruitment strategies, and how to maintain participant safety and confidentiality in the field. Following screening and consent, participants were administered The Los Angeles Transgender Health Survey described below. Both versions of the assessment took approximately 45 minutes to complete.

These Boards provided oversight for all study activities of the respective studies. Individual-level data from Study 1 were unavailable; however, the reported prevalence for each categorical variable was used to calculate count data. Fractional values of count data were rounded up to the greatest whole and prevalence estimates were adjusted accordingly.

Individual-level data for Study 2 were available and utilized to derive prevalence estimates. Chi-square tests for categorical variables were conducted to test for differences in sociodemographic factors, structural health determinants, HIV and STI prevalence and risk behaviors, substance use, gender confirmation procedures, and perceived discrimination by study Study 1: — vs.

Study 2: — SAS 9. Compared to participants in Study 1, participants in Study 2 were ificantly more likely to report being homeless 4. Access to healthcare insurance was ificantly higher in Study 2 compared to Study 1 Prevalence of participants with public healthcare insurance i. The weighted average of reported sex work as a main source of income in the past 6 months was HIV prevalence was higher in the Study 2 sample compared to Study 1 Prevalence of gonorrhea However, compared to Study 1, participants in Study 2 reported higher prevalence of condomless anal intercourse with every partner type: with any partner s Participants in Study 2 were less likely to use alcohol Participants in Study 2 were ificantly less likely to use cocaine Marginal ificance was observed for increase in discrimination in accessing HIV prevention services 4.

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To our knowledge, this study represents the first investigation of how structural determinants of health and risk behaviors among transgender women improved or worsened across a substantial time period, i. Findings reported here utilized data from two similar samples of transgender women in LAC using the same outreach and recruitment strategies, the same survey assessment, and both studies conducted by the same investigator first author.

These findings highlight that transgender women continue to face substantial barriers to achieving optimum or even satisfactory health outcomes.

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Prevalence of transgender women with access to healthcare insurance increased from just over one-third in Study 1 to over three-fourths in Study 2. This increase was likely ed for by a growth in access to public healthcare insurance i. It is a notable commentary on the Affordable Care Act that some of the most vulnerable Californians, such as moderate- and high-risk transgender women, were able to access public healthcare insurance.

Access to public healthcare insurance likely played a prominent role in increasing healthcare access between studies; changes in medically monitored hormone use between Study 1 and Study 2 highlighted positive s that healthcare access among transgender women increased between the two studies. Nearly half of the sample in Study 2 reported access to prescribed or medically monitored hormones compared to one-fifth of Study 1.

This is a promising finding given the known adverse health effects of unsupervised hormone use, including blood clots, elevated liver enzymes, gallstones, decrease in hemoglobin, and depression 29 — These findings point to the fact that along with healthcare insurance, healthcare access substantially increased, which is encouraging given the considerable health disparities faced by moderate- and high-risk transgender women.

While the aforementioned improvements in healthcare insurance and healthcare access were indeed promising, there remained numerous health determinants among transgender women that worsened over the 17 year period. Transgender women in both studies faced substantial structural i. Compared to the Study 1 sample, prevalence of homelessness in the Study 2 sample was nearly three-fold higher, and income was substantially lower, with Department of Housing and Urban Development estimated that the size of the homeless population in LAC was between 17, and 42, The increased of very low-income transgender women in Study 2, coupled with the LAC housing market likely explains the rise in homelessness between studies.

Furthermore, compared to Study 1, Study 2 evidenced elevated rates of receptive condomless anal intercourse with every partner type, including main partner scasual partner sand exchange partner s. These highlight that sexual risk behaviors among transgender women remain a key barrier to adequate prevention of HIV and STIs.

However, the increase in HIV and STI prevalence and sexual risk behaviors across samples highlights that, despite identifying transgender individuals as a funding priority and increased funding efforts, HIV, STIs, and sexual risk behaviors are both highly prevalent and difficult to prevent among transgender women. HIV and STI prevention efforts targeting moderate- and high-risk transgender women must take into the numerous structural barriers faced by the population, and ensure that HIV and STI prevention efforts consider and target this difficult-to-reach population.

For example, while Pre-exposure Prophylaxis PrEP is an effective biomedical HIV prevention strategy, the social and structural barriers that transgender women experience are associated with limited PrEP adherence 36 — Prior studies have demonstrated the associations between substance use and HIV and STI risk behaviors among transgender women 38 — The current study found mixed regarding substance use among transgender women. Compared to participants in Study 1, transgender women in Study 2 were less likely to drink alcohol, but more likely to use marijuana, both of which have been linked to condomless anal intercourse and HIV risk among transgender women 2 The higher rate of reported marijuana use is most likely a result in the policy shift related to medical marijuana in LAC, which contributed to increased availability and public acceptance of marijuana use.

Furthermore, methamphetamine use remained high and stable across both studies, with approximately one-fourth of both samples reporting methamphetamine use in the past six months; a troubling finding given the strong association between methamphetamine use and HIV sexual risk behaviors across numerous samples including transgender women 3843 — It is interesting to note that the consistently high rate of methamphetamine use is very similar to that found among samples of men who have sex with men in LAC, with approximately one-quarter of both populations reporting methamphetamine use from the current study indicate that high rates of substance use have persisted among transgender women in LAC, elucidating that HIV prevention efforts must target multiple levels of risk including both sexual risk and substance use behaviors.

Compared to Study 1, transgender women in Study 2 experienced similar or higher lifetime rates of discrimination, harassment and abuse in every category surveyed. Transgender women in both studies reported severely high prevalence of verbal and physical harassment and abuse. Verbal harassment and abuse was reported by over three-quarters of participants in both studies, and more Casual sex in Addis Los Angeles half of the Study 2 participants reported experiencing physical harassment and abuse, a ificant increase from Study 1.

Casual sex in Addis Los Angeles transgender women, experiences of harassment and abuse are associated with anxiety, depression, PTSD, and suicidality 47 — These mental health correlates have been reported as ificant barriers to employment and general functioning among transgender individuals 651 ; thus, placing transgender individuals at increased risk of poverty 38 and its associated detrimental health consequences. Given thesethe cyclical and syndemic nature of structural and interpersonal barriers to adequate health and wellbeing among transgender women is immense.

Reported discrimination in access to healthcare including refusal of care ificantly increased from Across numerous studies of transgender women, discrimination in accessing healthcare services has been linked to healthcare delay and avoidance and overall worse health outcomes, including lack of preventative healthcare 52 — While the aforementioned increase in access to healthcare insurance in Study 2 was a promising finding, the concurrent higher prevalence of reported healthcare discrimination, as well as the decrease in gender-related surgeries, with the exception of genital reconstruction i.

Additionally, with increased coverage of gender confirmation surgeries under the Affordable Care Act, the visibility of transgender persons in healthcare settings will simultaneously increase, further emphasizing the need for transgender-competent healthcare. As individual-level data from Study 1 were unavailable, differences between groups could only be measured utilizing count data, which led to the inability to conduct more robust, multivariate analyses.

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Although the two samples had some consistency regarding Casual sex in Addis Los Angeles characteristics, data were not longitudinal, both studies used convenience sampling, and any ificant differences between samples may be as a result of demographic or sampling differences, or the added eligibility criterion in Study 2, rather than true differences in health and risk behaviors. Furthermore, measures of health service utilization other than medically monitored hormone use were not collected; therefore, we cannot make any inferences regarding how structural, interpersonal and risk behavior differences across samples affected access to healthcare among the samples.

These data were limited in the self-reported nature of the survey e. An important limitation of both studies is that data were collected in LAC and may not be representative of transgender women in other regions of the U. Additionally, some participants were recruited through collaborating community-based organizations and; therefore, their data may not be representative of transgender women who do not access social service agencies.

As well, the high-risk nature of the sample makes these findings unlikely to be generalizable to transgender women who are less vulnerable than the participants in this study. Finally, while we can draw inferences about the effects of cultural, medical, and social shifts e. The marked increase in access to healthcare insurance coupled with prescribed and medically monitored hormones highlights the positive impact of government-funded healthcare insurance programs for this vulnerable population.

However, these findings must be tempered against the concurrent increase in reported prevalence of perceived healthcare discrimination. The authors would like to acknowledge the work of the research assistants from both Study 1 and Study 2 and their dedication to serve their community, and the participants in both studies. National Center for Biotechnology InformationU. AIDS Behav. Author manuscript; available in PMC Dec 5.

Cathy J. Reback1, 2, 3 Kirsty Clark4 Ian W. Holloway3, 5 and Jesse B.

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