En(coun)tering to Gender Performance: A Trans Woman’s Struggle in Nevada

Implementation Strategies for Creating Inclusive, All-Women HIV Care Environments: Perspectives From Trans and Cis Women.

Little is known about differences in HIV risk for trans women by partner gender, particularly with respect to social determinants of health and partner-level factors that affect behavior. We examined differences in demographic, social determinants, and HIV-related risk behaviors for trans women with cisgender men and trans women sexual partners. Data are from a cross-sectional survey of trans women and their sexual partners conducted between April 2020 and January 2021. Interviews were held remotely via videoconference during shelter-in-place ordinances due to the Covid-19 pandemic. This analysis characterized associations between HIV risk and preventive behaviors comparing trans women with cisgender men partners to trans women with trans women partners. A total of 336 sexual partners were identified from 156 trans women. Trans women with cisgender men partners were significantly more likely to be from racial/ethnic minority populations and all Black/African American and Latina trans women participants had cisgender men partners only. Trans women with cisgender men partners had significantly less education and employment and more incarceration and recidivism than trans women with trans women partners. Trans women and their cisgender men partners had shared experiences of unstable housing, incarceration, and HIV. Trans women with cisgender men partners reported significantly more sex exchange partners, receptive condomless sex, and HIV compared to trans women with trans women partners. Trans women with cisgender men sexual partners faced higher HIV risk than trans women with trans women sexual partners. These risks may be related to the social and economic drivers that both trans women and their cisgender men partners faced, namely structural racism that may explain barriers to education and employment, along with incarceration and recidivism. Interventions focused on economic stability, workforce development and post incarceration re-entry housing and employment support for trans women and their cisgender men partners may have the most impact on reducing HIV risk and incidence.

This was a qualitative study based on an analysis of narratives produced by travestis and transsexual women in Salvador, Bahia State, Brazil, with the aim of analyzing their experiences with stigmatization by describing events, actors, and contexts that have marked their life stories, as well as elucidating the relationship between stigma and their female performances. The narratives came from 19 in-depth interviews during an epidemiological survey, based on a prior script that explored the production of narratives on lifestyles and experiences of travestis and transsexual women in the city of Salvador. The life stories that emerged in the field were transcribed and analyzed from a theoretical and narrative perspective. The narratives of many travestis and transsexual women described an "effeminate" gender performance that had been identified since their childhood by family and community members. This performance was presented as insubordination to the power established by heteronormative society's legal system. The process of stigmatization begins to operate when social expectations concerning the coherence between "biological sex" and "gender performance" are frustrated in social interactions, submitting the individuals to discrimination and violence. Thus, stigmatization is operated through the power exercised over bodies by the laws of compulsory heterosexuality. However, during the life stories of travestis and transsexual women, strategies of resistance to stigma are produced, with the potential to transform this situation.

BackgroundIn the Middle East and North Africa region, there is a scarcity of studies that focus on transgender individuals. Not only this group is regarded as one of the most...

Latino men who have sex with transgender women make up an overlooked sector of the population that requires more attention than is currently given in sexuality and gender studies, particularly in regard to their non-commercial, long-term sexual and romantic relationships with transgender women. Sixty-one sexual histories were selected for this qualitative analysis from a larger study on Latino male bisexuality in the New York City metropolitan area. Findings suggest that participants’ sexual and gender scripts with transgender women are strongly regulated by heteronormativity. Furthermore, homonegativity and transphobia often intersect in the lived experiences of men who have sex with transgender women, resulting in relationship conflicts over the control of transgender women’s bodies, sexual behaviours and gender performance both in public and in private. Findings also suggest that low relationship conflict is more common among men who have sex with transgender women who exhibit diverse sexual roles (being both insertive and receptive during anal sex), or transgress heteronormative scripts through dialogue of desires and/or by embracing transgender women as human beings and not as hyperfeminised objects of desire. Stigma reduction and alternatives to heteronormative interventions are needed to improve relationship dynamics and potentially positively impact on the sexual health and overall wellbeing of Latino men who have sex with transgender women and their transgender partners.

BackgroundIn the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes.ObjectiveOur objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities.MethodsTo address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub–supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030.ResultsEnrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub–supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort.ConclusionsStudy findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research.International Registered Report Identifier (IRRID)DERR1-10.2196/59846

Nothing Compares to You

HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to “rescript” social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined “high-risk populations.” Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert–patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.

RESUMOObjetivo: identificar as representações sociais de mulheres transexuais jovens, acometidas por HIV/aids, na construção das condutas preventivas. Método: estudo qualitativo, descritivo, exploratório. A população será composta por mulheres transexuais. O cenário do estudo será um hospital de referência para pessoas com HIV/Aids, localizado na cidade do Recife (PE), Brasil. Para a produção dos dados serão realizadas entrevistas semiestruturadas, que serão analisadas com o auxílio do software Iramuteq. Resultados esperados: as mulheres transexuais vivenciam contexto de vulnerabilidade ao HIV/aids resultante da exclusão social, marginalização e estigma. Neste contexto a representação social está associada a ideia de morte desmerecedora, intenções e possibilidades subjacentes às condutas preventivas. Descritores: Teoria Social; Educação em Saúde; Pessoas Transgênero; HIV; Síndrome da Imunodeficiência Adquirida; Enfermagem.ABSTRACT Objective: to identify the social representations of transsexual women, young people affected by HIV/aids, in the construction of preventive behaviors. Method: a qualitative study, descriptive, exploratory. The population will consist of transsexual women. The scenario of the study will be a reference hospital for people with HIV/Aids, located in the city of Recife (PE), Brazil. For the production of data will be conducted semi-structured interviews, which will be analyzed with the aid of the software Iramuteq. Expected results: transsexual women experience context of vulnerability to HIV/AIDS resulting from social exclusion, marginalisation and stigma. In this context the social representation is associated with the idea of death without deserving, intentions and possibilities underlying the preventive behaviors. Descriptors: Social Theory; Transgender Persons; Health Education; HIV; Acquired Immunodeficiency Syndrome; Nursing. RESUMEN Objetivo: identificar las representaciones sociales de las mujeres transexuales, jóvenes afectados por el VIH/SIDA, en la construcción de conductas preventivas. Método: un estudio cualitativo, descriptivo, exploratorio. La población estará compuesta de mujeres transexuales. El escenario del estudio será un hospital de referencia para las personas con VIH/SIDA, ubicado en la ciudad de Recife (PE), Brasil. Para la producción de los datos se realizaron entrevistas semi-estructuradas, que serán analizadas con la ayuda del software Iramuteq. Resultados esperados: la experiencia de las mujeres transexuales contexto de vulnerabilidad al VIH/sida resultante de la exclusión social, la marginación y la estigmatización. En este contexto la representación social está asociada con la idea de la muerte desmerecedora, intenciones y posibilidades subyacentes a los comportamientos preventivos. Descriptores: Teoría Social; Personas Transgénero; Educación en Salud; VIH; Síndrome de Inmunodeficiencia Adquirida; Enfermería.

Objective: Transgender women encounter various barriers to healthcare access and use. Together, these contribute to under-utilisation, delay or avoidance of the healthcare system. This in-depth qualitative phenomenological study aimed to explore perceptions, interactions and experiences with medical and healthcare systems, and identify suggestions for improving healthcare access and utilisation among transgender women. Design/Setting: Fifteen ( N = 15) transgender women in Los Angeles County participated in semi-structured telephone interviews. Method: Participants were recruited through emails sent to LGBTQ+ serving institutions, health centres and college campuses. The interview guide covered demographic information, experiences within medical and healthcare setting, interactions and perceptions within clinical settings, and concerns about barriers to healthcare access and utilisation. Results: Healthcare experiences were shaped by interpersonal and structural factors. Four themes were identified: (1) lack of trained and knowledgeable healthcare providers, (2) limitations in healthcare access such as cost and hormone replacement therapy access, (3) implicit bias regarding being misgendered and stereotyped, and (4) explicit bias such as denial of services, inability adding preferred personal information to medical health records, and various aspects of discrimination. Conclusion: Access to knowledgeable healthcare providers was cited as a priority area needing the most attention. Curricula and modules that address social, medical and clinical issues specific to transgender women were suggested for use in the training and continuing education of healthcare professionals. In addition to needs related to patient–provider contact, this paper highlights the broader regulatory and political changes needed to improve the health of transgender women.

to analyze the social representations of HIV vulnerability in transgender women. this qualitative study was based on the Theory of Social Representations, using the structural approach. The research was conducted in a hospital specializing in gender-affirming surgeries, involving 100 self-declared transgender women. The Free Word Association technique was applied using the inducing term "HIV exposure in transgender women" to obtain representational content. Data analysis was performed using the four-quadrant technique, facilitated by the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2. the possible central nucleus identified included the terms "prevention, prostitution as a profession, prejudice, and risky behavior". Social and individual issues were highlighted as important elements in the vulnerability process. the social representations of HIV vulnerability in transgender women are grounded in structural factors that lead to inequality, exclusion, prejudice, and discrimination.

Fertility preservation in trans women is a crucial but thus far neglected component in the gender confirming treatment in Germany. It is difficult for trans women to access reproductive health care because centers offering treatment, psychological guidance, gender confirming surgery, as well as reproductive health services are scarce in Germany. Legal, social, or financial issues as well as individual patient comorbidities prevent trans women from receiving appropriate counselling. This review provides an overview on options of fertility preservation in trans women. We consider recent publications on testicular regression at the time of gender confirming surgery demonstrating presence of sperm or at least spermatogonia in the majority of tissues. This may open options for cryopreservation of sperm or testicular stem cells in trans women even at the final stage of transition. Hence, standardized urological procedures (i.e., sperm cryopreservation after masturbation or sperm extraction from the testicular tissue) and experimental approaches (cryopreservation of testicular tissue with undifferentiated spermatogonia) can be offered best at the initiation but also during the gender confirming process. However, counselling early in the gender confirming process increases the chances of fertility preservation because gender confirming hormone therapy has an impact on spermatogenesis.

Guided by the relational cultural theory, we conducted a qualitative study to examine the relationship experiences of African American transgender women living in North Carolina. A convenience sample of 15 transgender women participated in the study. Semi-structured interviews, guided by an investigator-developed interview guide, were used to explore the personal experiences of transgender women on individual, family, and organizational levels. The findings provide a scheme for understanding the process through which transgender women's relationships hinder or enhance their ability to connect with individuals, family, and organizations. Nurses can use these findings to better understand the connectedness that occurs or does not occur in transgender women's relationships and provide culturally competent care to empower them to become resilient.

Opposing social movements are groups that have conflicting objectives on a shared social justice issue. To maximize the probability of their movement's success, groups can strategically portray their group in a favourable manner while discrediting their opposition. One such approach involves the construction of victimization discourses. In this research, we combined topic modelling and critical discursive psychology to explore how opposing groups within the feminist movement used victimization as a lens to understand their movements in relation to transgender women. We compiled a dataset of over 40,000 tweets from 14 UK‐based feminist accounts that included transgender women as women (the pro‐inclusion group) and 13 accounts, that excluded transgender women (the anti‐inclusion group). Our results revealed differences in how victimization was employed by the opposing movements: pro‐inclusion groups drew on repertoires that created a sense of shared victimhood between cisgender women and transgender women, while anti‐inclusion groups invoked a competitive victimhood repertoire. Both groups also challenged and delegitimised their oppositions' constructions of feminism and victimhood. These findings add to our understanding of the communication strategies used by opposing movements to achieve their mobilization goals.

In Vietnam, HIV continues disproportionately to affect men who have sex with men and transgender women, and the increase in HIV prevalence in these populations may be related to a lack of tailoring of current prevention approaches, which often fail to address social diversity within these populations. To effectively respond to HIV in Vietnam, it is imperative to identify sub-populations within the broad category of ‘men who have sex with men’ (MSM), a term which in Vietnam as in many other sites frequently subsumes transgender women. In this paper, we document the different categories used to describe people who engage in same-sex sexual practices and/or non-normative gender performances drawing on data collected via in-depth interviews and focus groups with a total of 79 participants in Hanoi. We identified over 40 different categories used to describe men who have sex with men and/or transgender women. These categories could be described as behaviourally-based, identity-based, or emic, and each carried different meanings, uses (based on age and geography) and levels of stigma. The categories shine light on the complexity of identities among men who have sex with men and transgender women and have utility for future research and programming to more comprehensively address HIV in Vietnam.