Forming Genuine Bonds: HIV Research Retention Strategies for Cisgender Women Vulnerable to HIV Acquisition.

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.

Our study was conducted to estimate intimate partner violence (IPV) prevalence and associated factors among trans and cisgender women at risk of or living with HIV during the coronavirus disease (COVID-19) pandemic in Rio de Janeiro, Brazil. A cross-sectional study was conducted between May and August 2020 through telephone surveys with cisgender and trans women enrolled in two cohort studies in Rio de Janeiro. We assessed IPV employing the Revised Conflict Tactics Scale during the initial months of shelter-in-place ordinances. Regression models evaluated the factors associated with IPV for each population. We surveyed 796 women, and 341 participants (47.78%) were eligible and included in the current analysis. All cisgender women and 41 (64.06%) trans women were living with HIV. Overall IPV prevalence was 27.86% (95% confidence interval [95% CI] 23.34-32.88). IPV was 63% higher among trans women than among cisgender women (prevalence ratio 1.63, 95% CI 1.14-2.34, p=0.008). Loneliness was significantly associated with IPV in both groups. Younger age and binge drinking were associated with IPV prevalence among trans women. For cisgender women, IPV was associated with withdrawal of cash transfer programs during the shelter-in-place. Trans women experienced significantly more IPV than cisgender women in the early phase of the COVID-19 epidemic. Plans to prevent and address violence against cisgender and trans women, especially those with heightened vulnerability that may be associated with living with HIV, are needed in public health planning for future pandemics.

BackgroundCisgender women account for 1 in 5 new HIV infections in the United States, yet remain under-engaged in HIV prevention. Women experiencing violence face risk for HIV due to biological and behavioral mechanisms, and barriers to prevention, such as challenges to Pre-Exposure Prophylaxis for HIV Prevention (PrEP) adherence. In this analysis, we aim to characterize intimate partner violence (IPV) among cisgender heterosexual women enrolled in a PrEP demonstration project and assess the associations with PrEP adherence.MethodsAdherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label study of PrEP adherence in HIV-negative cisgender women in Southern California (N = 130) offered daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). From 6/2016 to 10/2018, women completed a survey reporting HIV risk behavior and experiences of any IPV (past 90-days) and IPV sub-types (past-year, lifetime) and biological testing for HIV/STIs at baseline, and concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots at weeks 4, 12, 24, 36, and 48. Outcomes were TFV-DP concentrations consistent with ≥ 4 or ≥ 6 doses/week at one or multiple visits. Multivariable logistic regression models were conducted to examine associations.ResultsPast-90-day IPV was reported by 34.4% of participants, and past-year and lifetime subtypes reported by 11.5-41.5%, and 21.5-52.3%, respectively. Women who engaged in sex work and Black women were significantly more likely to report IPV than others. Lifetime physical IPV was negatively associated with adherence at ≥ 4 doses/week at ≥ 3 of 5 visits, while other relationships with any IPV and IPV sub-types were variable.ConclusionIPV is an indication for PrEP and important indicator of HIV risk; our findings suggest that physical IPV may also negatively impact long-term PrEP adherence.Clinical Trials RegistrationNCT02584140 (ClinicalTrials.gov), registered 15/10/2015.

We investigated the odds of intimate partner violence (IPV) among primary care patients across subgroups of transgender and gender nonconforming (TGNC) individuals relative to cisgender women, and cisgender sexual minority men and women relative to cisgender heterosexual men and women. Participants completed an IPV screener as part of routine primary care visits at an urban community health center (N = 7572). Electronic medical record data were pooled for all patients who received the IPV screener January 1 to December 31, 2014. Overall, 3.6% of the sample reported experiencing physical or sexual IPV in the past year. Compared to cisgender women (past-year prevalence 2.7%), all TGNC subgroups reported elevated odds of physical or sexual IPV, including transgender women (past-year prevalence 12.1%; adjusted odds ratio [AOR] = 5.0, 95% confidence interval [CI] = 2.9-8.6), transgender men (6.6%; AOR = 2.4, 95% CI: 1.2-4.6), gender non-binary individuals (8.2%, AOR = 3.1, 95% CI = 1.7-5.4), and TGNC individuals who did not report their gender identity (9.1%; AOR = 3.7, 95% CI = 2.2-6.3). The prevalence of isolation-related IPV and controlling behaviors was also high in some TGNC groups. Our findings support that IPV is prevalent across genders and sexual orientations. Clinical guidelines for IPV screening should be expanded to include TGNC individuals and not just cisgender women. Future research could explore the complex patterns by which individuals of different genders are at increased risk for different types of IPV, and investigate the best ways to screen TGNC patients and support TGNC survivors.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

During the last 20 years, trans and gender non-conforming (TGNC) individuals have become more visible in social activism, politics, and popular media. Concomitant with this visibility has been greater recognition and acceptance of the fluidity and non-binary quality of some people’s gender identity. Despite these positive changes, TGNC individuals still face widespread prejudice and discrimination, such as the creation of so-called “bathroom bills,” proposed restrictions on access to health care, and instigated attempts by the federal government to legislate the definition of “gender.” Research examining the roots of trans prejudice, or prejudice toward trans people, indicates that negative attitudes may be associated with traditional gender role beliefs, anti-feminist attitudes, moral disgust toward trans people, and a belief that trans people are psychologically disturbed. Perceived threats to social values and sexual safety posed by trans people may also underlie trans prejudice among cisgender heterosexual individuals in particular. Also, there is evidence that these perceived threats vary depending on the gender identity of the trans person as well as the cisgender individual. An examination of the origins of and the factors that predict trans prejudice will contribute to a better understanding of the high levels of sexual assault, harassment, and intimate partner violence (IPV) reported by trans people in recent surveys. Furthermore, such an understanding may contribute to systemic changes in the treatment of trans people by their family, friends, intimate partners, as well as health care professionals.

Intimate partner violence (IPV) is a health concern that ghas been commonly examined in heterosexual individuals. Perceptions of IPV towards White, cisgender women have further been examined. Due to the high prevalence of IPV towards Black and transgender women, research regarding individuals’ attitudes towards these victims is warranted. Participants were recruited from Amazon’s Mechanical Turk (N = 198) and randomly assigned to read one of four hypothetical scenarios that depicted either a Black or White cisgender or transgender woman experiencing IPV perpetrated by her male partner. Participants were asked how much they blamed the victim, excused the perpetrator, and supported the victim. A 2 × 2 × 2 MANOVA was conducted to examine differences between participant gender, the hypothetical victim’s race, and the hypothetical victim’s gender identity. There were no main effects or three-way interaction, but there was a statistically significant interaction between victim race and victim gender identity. Multiple regression analyses also were conducted to examine the influence of predictor variables (i.e. racism, gender role ideology, transnegativity, acceptance of IPV myths, and neutralising IPV beliefs) on victim blaming, excusing the perpetrator, and supporting the victim. There were statistically significant findings for the predictor variables on the dependent variables. Implications for the findings and future research directions are discussed.

Introduction:Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes.Objectives:This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus.Methods:We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States.Results:Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum.Conclusion:Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre–post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.

Recent Intimate Partner Violence and Housing Instability Among Women Veterans

A Longitudinal Investigation of Intimate Partner Violence Among Mothers With Mental Illness

Severe mental illness, substance use, and intimate partner violence have emerged as major intersecting public health problems that adversely and disproportionately impact the lives of women in the United States. This longitudinal study investigated the demographic and clinical correlates of intimate partner violence in a sample of 324 mothers with severe mental illness. A secondary analysis of longitudinal data was conducted by using multiple logistic regression. Participants were part of a longitudinal, community-based study of mothers with severe mental illness, which was aimed at understanding how these mothers viewed motherhood. The women were interviewed initially at baseline (interviews were conducted between 1995 and 1996) and then about 20 months later at follow-up (interviews were conducted between 1997 and 1998). At follow-up the prevalence rate of intimate partner violence was 19%. Multiple logistic regression analyses showed a significant positive relationship between alcohol and drug misuse at baseline and intimate partner violence at follow-up, indicating that women with a co-occurring diagnosis of a substance use disorder (dual diagnosis) were more likely than women without such a diagnosis to report intimate partner violence. The number of lifetime psychiatric hospitalizations and the number of symptoms related to psychiatric disability exhibited at baseline were positively associated with intimate partner violence at follow-up, and age was inversely associated with intimate partner violence. Mental health professionals serving mothers with mental health problems need to be aware of and prepared to assess the significant correlation between these intersecting public health problems in order to influence successful interventions. Particular attention must be given to the special treatment needs related to dual diagnosis and victimization and the impact of these factors on this vulnerable population.

Background Intimate partner violence (IPV) is a serious public health issue in sexual and gender minority people assigned male at birth (SGM-AMAB), with rates at or above those of cisgender women. However, there is little research on how IPV exposure may impact alcohol and drug use (DU) in this population, impeding holistic intervention development. This study investigated whether experiences of IPV lead to higher rates of substance use over time among SGM-AMAB. Methods Data from the RADAR cohort study of Chicago-based SGM-AMAB (n=1,239) were used. Cross-lagged generalized estimating equations with repeated measures and Poisson regression models examined if experiences of IPV at one timepoint predicted DU and hazardous alcohol use 6 months later over a five-year period. Findings About one in five (19%) participants reported physical, sexual, or emotional IPV in the six months before visit 1. While all participants’ DU increased across the study period (adjusted risk ratio [aRR] = 1.026, 95% CI = 1.012–1.041, p = .0003), participants reporting any IPV at a given timepoint were more likely to report greater DU 6 months later (aRR = 1.145, CI = 1.055–1.242, p = .0012) than those who did not report IPV. Similarly, participants reporting any IPV were more likely to report high-risk alcohol use 6 months later (aRR = 1.033, 95% CI = 1.002–1.064, p = .0344). Conclusion This study is among the first to investigate temporal relationships between IPV, DU, and hazardous alcohol use in SGM-AMAB. The findings indicate a high burden of IPV, alcohol misuse, and substance misuse in this population, reinforcing that both violence and substance use are important issues in these communities. Results suggest IPV prevention and mitigation should be integrated into holistic substance use reduction efforts for SGM-AMAB. Short Summary This longitudinal study examined how IPV affects substance and alcohol use among SGM-AMAB. Using data from 1,239 participants over five years, the research found that experiencing IPV significantly predicted increased drug use and hazardous alcohol consumption six months post-violence. This study provides critical evidence supporting the integration of IPV prevention and mitigation into substance use interventions for SGM-AMAB communities.

Although some evidence suggests that cyber intimate partner violence (IPV) may increase the risk of in-person IPV, some have suggested that cyber IPV may circumvent in-person IPV. To address these mixed hypotheses, the present study tested the hypothesis that cyber IPV perpetration and victimization would associate with greater odds of same and next-day psychological, physical, and sexual IPV perpetration and victimization among college students. College students (N = 236; 73.73% cisgender women) in dating relationships completed a baseline questionnaire to assess demographic characteristics and past-year cyber, psychological, physical, and sexual IPV. Following baseline assessments, participants completed 60 consecutive days of surveys on cyber, psychological, physical, and sexual IPV perpetration and victimization (71.67% compliance). Hypotheses were partially supported. Cyber IPV perpetration positively associated with odds of same-day psychological IPV perpetration (aOR = 2.46, p = .02) and next-day sexual IPV perpetration (aOR = 3.32, p < .001). Cyber IPV victimization positively associated with odds of same-day psychological IPV victimization (aOR = 5.20, p = .00). Results demonstrate that college students experience IPV both online and in-person within a single day. Cyber IPV may be a targetable antecedent to in-person sexual and psychological IPV. Future research is needed to evaluate the impact of same- and next-day polyvictimization, bidirectional cyber and in-person IPV, and the effectiveness of targeting cyber IPV prevention programming among college students.

Understanding HIV risk and vulnerability among cisgender men with transgender partners

Improving Health Equity for Women Involved in the Criminal Legal System.