"We Might Get Some Free Beers": Experience and Motivation for Transactional Sex among Behaviorally Bisexual Men in Vientiane, Laos

People engaging in transactional sex are considered a key population for HIV prevention. Prior quantitative surveys demonstrated that behaviorally bisexual men in Vientiane, Laos commonly transact sex. 

In 2013, we conducted a qualitative study to explore behaviorally bisexual men's experience, motivations, and perceptions related to transactional sex in Vientiane. Behaviorally bisexual men were recruited from bars, nightclubs, and dormitories for five focus group discussions (FGDs) and 11 in-depth interviews (n = 31). Additionally, young women were recruited from a university, garment factory, and nightclub for four FGDs (n = 22). Transcripts were translated and thematically coded. 

Bisexual male participants most commonly described being paid for sex by male-to-female transgender people and buying sex from women. Both male and female participants reported that older, single women pay younger men for sex. Negotiation and direction of sexual transactions are influenced by age, attraction, and wealth. Common motivations for selling sex included the need for money to support family or fund school fees, material gain, or physical pleasure. Transactional sex was often opportunistic. Some behaviorally bisexual men reported selling sex in order to pay another more desirable sex partner or to buy gifts for their regular sex partner. Participants perceived high risk associated with intercourse with female sex workers but not with other transactional sex partners. 

Health interventions are needed to improve knowledge, risk perception, and health behaviors, but must recognize the diversity of transactional sex in Vientiane. Both physical and virtual settings may be appropriate for reaching behaviorally bisexual men and their partners.

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By:  Bowring AL1,2, Pasomsouk N3, Hughes C4, van Gemert C5,6, Higgs P5,7, Sychareun V8, Hellard M5,6, Power R6,4,9.

• 1Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia. annab@burnet.edu.au.
• 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. annab@burnet.edu.au.
• 3Burnet Institute, Vientiane, Lao PDR.
• 4Centre for International Health, Burnet Institute, Melbourne, Australia.
• 5Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia.
• 6Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
• 7Faculty of Health Sciences, National Drug Research Institute, Curtin University, Fitzroy, Melbourne, Australia.
• 8Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.
• 9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
• Arch Sex Behav. 2016 Mar 23.  

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Transgender health care horror stories - Video

Via:  https://goo.gl/hl6FB1

Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

Objective

To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women.

Methods

Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’

Findings

Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries.

Conclusions

Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.

Below:  Categorization of population size estimates of female sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries, 2010–2014

Full article at:   http://goo.gl/wG4uNP

By:  

Keith Sabin, Sonia Arias Garcia 
Strategic Information and Evaluation Department, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland

Jinkou Zhao, Yaou Sheng, Annette Reinisch 

Technical Advice and Partnerships Department, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

Jinkou Zhao

Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

Jesus Maria Garcia Calleja 

Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

Ryuichi Komatsu 

Technical Evaluation Reference Group Support Team, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

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HIV Prevalence and Risks Associated with HIV Infection among Transgender Individuals in Cambodia

INTRODUCTION:

Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia.

METHODS:

Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited.

RESULTS:

The majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20-27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35-44 and adjusted OR = 7.63 [2.55, 22.81] for age 30-34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37,23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09,7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR = 3.25 [1.35,7.85]) were independently associated with HIV infection.

Below:  A. Condom use with partners during past 6 months by sex transaction type, with female partners. B. Condom use with partners during past 6 months by sex transaction type, with male partners.

CONCLUSIONS:

This study confirms transgender individuals as one of the highest-risk groups for HIV infection in Cambodia. It suggests the need for programmatic strategies that mitigate identified associated risks and facilitate access to HIV care for this population.

Full article at:   http://goo.gl/MDR3Ih

By:  Weissman A1, Ngak S1, Srean C1, Sansothy N2, Mills S3, Ferradini L1.

• 1FHI 360, Phnom Penh, Cambodia.
• 2National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, (NCHADS) and University of Health Science, Phnom Penh, Cambodia.
• 3FHI 360, Bangkok, Thailand. 

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Acceptability of Three Novel HIV Prevention Methods among Young Male and Transgender Female Sex Workers in Puerto Rico

Sex workers need HIV-prevention methods they can control and incorporate easily in their work. We studied the acceptability of three methods: HIV self-test use with clients, oral pre-exposure prophylaxis (PrEP), and rectal microbicide gel. 

Four male and eight transgender female (TGF) sex workers in Puerto Rico completed a baseline survey with a quantitative measure of likelihood of use. From them, one male and four TGF also completed a 12-week study of rectal microbicide placebo gel use prior to receptive anal intercourse with male clients and evaluated via qualitative in-depth interviews and follow-up quantitative assessments how each method could be incorporated into their work. 

Most were interested in a rectal microbicide gel and able to use it covertly with clients. Challenges to using the HIV self-test with clients included the potential for both breach of confidentiality and confronting violent situations. Participants also expressed interest in oral PrEP, but raised concerns about side effects.

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By:  Giguere R1, Frasca T2, Dolezal C2, Febo I3, Cranston RD4, Mayer K5, McGowan I4, Carballo-Diéguez A2.

• 1Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA. giguere@nyspi.columbia.edu.
• 2Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
• 3Department of Pediatrics, Gama Project, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA.
• 4School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
• 5Fenway Health, Fenway Institute, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
• AIDS Behav. 2016 Apr 5. 

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Face-ism and Objectification in Mainstream and LGBT Magazines

In visual media, men are often shown with more facial prominence than women, a manifestation of sexism that has been labeled face-ism. 

The present research extended the study of facial prominence and gender representation in media to include magazines aimed at lesbian, gay, bisexual, and transgender (LGBT) audiences for the first time, and also examined whether overall gender differences in facial prominence can still be found in mainstream magazines. Face-ism emerged in Newsweek, but not in Time, The Advocate, or Out. Although there were no overall differences in facial prominence between mainstream and LGBT magazines, there were differences in the facial prominence of men and women among the four magazines included in the present study. 

These results suggest that face-ism is still a problem, but that it may be restricted to certain magazines. Furthermore, future research may benefit from considering individual magazine titles rather than broader categories of magazines, given that the present study found few similarities between different magazines in the same media category—indeed, Out and Time were more similar to each other than they were to the other magazine in their respective categories.

Below:  Face-ism Indices of Men and Women in Two Mainstream and Two LGBT Magazines

Full article at:   http://goo.gl/tMvVue

By:  Nathan N. Cheek 

Department of Psychology, Swarthmore College, Swarthmore, PA, United States of America

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Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study

PURPOSE:

There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.

METHODS:

Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population.

RESULTS:

In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.

CONCLUSION:

This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

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By:  Brown GR1,2, Jones KT3.

• 1 Psychiatry Service, Mountain Home Veterans Affairs Medical Center , Johnson City, Tennessee.
• 2 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University , Johnson City, Tennessee.
• 3 Office of Health Equity , Veterans Health Administration, Washington, District of Columbia.
• LGBT Health. 2016 Apr;3(2):122-31. doi: 10.1089/lgbt.2015.0058. Epub 2015 Dec 16. 

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Syndemic Factors associated with Drinking Patterns among Latino Men and Latina Transgender Women Who Have Sex with Men in New York City

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. 

The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. 

We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. 

In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. 

Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.

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By:  Omar Martinez^a*, Elwin Wu^b, Ethan C. Levine^c, Miguel Muñoz-Laboy^d, Joseph Spadafino^e, Brian Dodge^f, Scott D. Rhodes^g,Javier López Rios^h, Hugo Ovejeroⁱ, Eva M. Moya^j, Silvia Chavez Baray^j, Alex Carballo-Diéguez^h & M. Isabel Fernandez^k

• ^a Temple University School of Social Work, Philadelphia, PA, USA;
• ^b School of Social Work at Columbia University, New York, NY, USA;
• ^c Department College of Liberal Arts at Temple University, Philadelphia, PA, USA;
• ^d College of Public Health at Temple University, Philadelphia, PA, USA;
• ^e Bureau of Public Health Statistics, Phoenix, AZ, USA;
• ^f School of Public Health at Indiana University – Bloomington, Bloomington, IN, USA;
• ^g Wake Forest School of Medicine, Winston-Salem, NC, USA;
• ^h HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA;
• ⁱ Lutheran Family Health Center, Brooklyn, NY, USA;
• ^j School of Social Work at the University of Texas at El Paso, El Paso, TX, USA;
• ^k Department of Public Health at Nova Southeastern University, Fort Lauderdale, FL, USA

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The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: Experience from ‘HIM’ initiative

Introduction

The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15–24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%.

Methods

Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services.

Results and discussion

A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections.

Conclusion

The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.

Below:  Distribution of turnaround time for voucher redemption to access sexual and reproductive health and HIV services among respondents

Predictors of voucher turnaround time among young MSM and transgenders in Dhaka, Bangladesh

Social Characteristics	Within 7 days		Within 14 days
	Odds ratio exp β (95% CI)	P value	Odds ratio exp β (95% CI)	P value
Age
20–24 years (rc)
15–19 years	0.37 (0.20–0.67)	0.001	0.33 (0.17–0.64)	0.001
Highest education level
None/primary education (rc)
Secondary education	0.42 (0.17–1.04)	0.059	0.44 (0.16–1.19)	0.105
Postsecondary education	0.34 (0.12–0.99)	0.047	0.20 (0.06–0.65)	0.008
Population group
Young MSM (rc)
Young transgender people	0.18 (0.03–0.97)	0.047	0.44 (0.09–2.04)	0.291
Occupation
Nonstudents (rc)
Students	1.16 (0.50–2.71)	0.732	1.85 (0.73–4.66)	0.196
Location of social network
Areas within and around tertiary institutions (rc)
Open parks and recreation centres	0.82 (0.39–1.73)	0.606	0.89 (0.39–2.01)	0.777
Municipal areas	2.64 (0.40–17.38)	0.313	0.53 (0.90–3.09)	0.477
Resource centres	0.67 (0.22–2.07)	0.483	0.42 (0.13–1.37)	0.152
Constant	5.24 (1.83–15.00)	0.002	12.05 (3.57–40.73)	0.00
Total number of cases	210		210
Model χ2 (df = 8)	21.47		21.85
Model significance (P value)	0.006		0.0052
log likelihood	−134.588		−122.041

CI, confidence interval; rc, reference category.

Full article at:  http://goo.gl/pWRV2T

By:  Tajudeen O. Oyewale,a,† Shale Ahmed,b Farid Ahmed,f Mona Tazreen,f,∗ Ziya Uddin,c,† Anisur Rahman,d and Kola A. Oyedirane,‡

^aHIV Section, United Nations Children's Fund, New York City, New York, USA

^bBandhu Social Welfare Society

^cHIV Programme, United Nations Children's Fund

^dNational AIDS/STD Programme, Ministry of Health and Family Welfare, Dhaka, Bangladesh

^eJohn Snow Inc., Arlington, Virginia, USA

^fHIV Programme, UNICEF Bangladesh, Dhaka, Bangladesh

Correspondence to Tajudeen O. Oyewale, MBBS, MPH, PhD, UNICEF House, 3 UN Plaza, New York 10017, NY, USA. Tel: +1 212 326 7567; 

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Psychiatric Comorbidities in Transsexualism: Study of a Lebanese Transgender Population

INTRODUCTION:

The question of whether gender dysphoria is associated with psychiatric comorbidity has been addressed in several studies. Several cohort studies have shown that psychiatric comorbidity is one of the main features of poor prognosis following sex change therapy. Gender dysphoria is rare, with an estimated prevalence of 0.001% to 0.002% globally. The literature shows a high prevalence of psychiatric comorbidities in people with gender dysphoria, and that they are more common in male to female transsexuals. Data on long-term mortality show that transsexuals present a 51 % increase in mortality compared to the general population. This is mainly attributed to a six-fold increase in the number of suicides and a higher rate of psychiatric disorders and risky behaviors leading to HIV infection and substance abuse.

PURPOSE:

Assess psychiatric comorbidity in a population of Lebanese transgender individuals and compare it to the general population. The hypothesis of our study is that the Lebanese transgenders suffer from more psychiatric comorbidities than the general population. Our second objective was to determine the specific mental health needs of this population in order to adapt our services to their medical needs and their specific concerns.

METHODS:

Our objective was to acquire 20 transgender participants and 20 control subjects. We chose a snowball sampling method. The evaluation consisted of three questionnaires including a general demographic questionnaire, the MINI 5.0.0 Arabic version for axis I disorders and the SCID-II for axis II disorders.

RESULTS:

The mean age of both groups was 23.55 years. Fifty-five percent (n=11) transgender participants had active suicidal thoughts against 0 % in controls. Within the group of transgender, 45 % (n=9) had a major depressive episode, 5 % (n=1) had a generalized anxiety disorder, 5 % (n=1) had a posttraumatic stress disorder and 10 % (n=2) had a major depressive episode with comorbid posttraumatic stress disorder. We noted a significant difference between the two groups regarding the presence of suicidal ideation (P=0.000) and the presence of axis I disorders (P=0.039).

DISCUSSION:

In our study, we noted demographic and economic characteristics specific to the population of transgender individuals. We found a significant difference in the level of education, economic status and household composition. Transgender individuals suffer from more psychiatric pathologies compared to the general population. This may be due to social and familial discrimination and ostracism. These results demonstrate the vulnerability of this population. An awareness program for mental health professionals is essential in order to adapt care to the specific needs of this population. A list of non "transphobic" mental health professionals should be established.

Purchase full article [Article in French] at:   http://goo.gl/vJQRE4

By:  Ibrahim C1, Haddad R2, Richa S3.

• 1Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Liban.
• 2Faculté de médecine, université Saint-Joseph, Beyrouth, Liban.
• 3Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Liban; Faculté de médecine, université Saint-Joseph, Beyrouth, Liban. Electronic address: sami.richa@usj.edu.lb.
• Encephale. 2016 Mar 23. pii: S0013-7006(16)00043-9. doi: 10.1016/j.encep.2016.02.011.  

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