Cisgender Research Articles

PrEP Use in a US National Sample of Trans Men and Other Transmasculine People Who Have Sex With Men: A Longitudinal Analysis

Introduction: Efforts to improve pre-exposure prophylaxis (PrEP) uptake among gay men, transgender women, and Black cisgender women are evident across the United States, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other transmasculine people who have sex with men (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning has yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. Methods: Using data from a prospective US national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. Results: Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24 months, with about one-third of users discontinuing within 1 year. Health insurance, having had lower surgery, used post-exposure prophylaxis, or recently having a sexually transmitted infection were associated with increased odds of PrEP use. Conclusion: We found low uptake of PrEP and high discontinuation rates in a US national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.

Leveraging Human-Centered Design to Promote Community-Level Antiracism Efforts: A Pilot Study of the Innovation Change Lab

ABSTRACT The present study piloted Innovation Change Lab (ICL), a novel intervention to promote antiracism and human-centered design (HCD) in a rural community. Data included (1) a pre- and post-survey of antiracist attitudes; (2) post-workshop feedback surveys, and (3) a focus group at the end of the training. Participants (n = 14) identified their race as White (n = 7), Latine (n = 3), Multiracial (n = 1); and their genders as cisgender women (n = 12) and cisgender men (n = 2). Attitude change was analyzed using one-tailed t-tests. Qualitative analysis of open-ended survey questions and focus group data was conducted using content analysis. Participants reported that, with some exceptions, the curriculum was feasible and acceptable. They reported increasing their knowledge about antiacism concepts and critical racial consciousness. ICL showed evidence of shifting individual attitudes toward antiracism and increasing one’s confidence in taking action on social justice. Learning about microaggressions, cross-group discussions about socialization and race, and conducting empathy interviews with folks impacted by racism were the most impactful aspects of the curriculum. Challenges arose around taking action to change systems implicated in sustaining racism. Despite challenges, findings suggest HCD may offer strategies to support intra- and inter-personal change necessary to move toward antiracist action.

Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis.

Black cisgender women (hereafter referred to as "women") experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, "POWER Up") to improve PrEP uptake among women. RR2-10.1371/journal.pone.0285858.

Can acoustic measurements predict gender perception in the voice?

To determine if there is an association between vocal gender presentation and the gender and context of the listener. Quantitative and transversal study. 47 speakers of Brazilian Portuguese of different genders were recorded. Recordings included sustained vowel emission, connected speech, and the expressive recital of a poem. Subsequently, four scripts were used in Praat to extract 16 acoustic measurements related to prosody. Voices underwent Auditory-Perceptual Assessment (APA) of the gender presentation by 236 people [65 speech and language pathologist (SLP) with experience in the area of the voice (SLP), 101 cisgender people (CG), and 70 transgender and non-binary people (TNB)]. Gender presentation was evaluated by visual analogue scale. Agreement analyses were executed among quantitative variables and multiple linear regression models were generated to predict APA, taking the judge context/gender and speaker gender into consideration. Acoustic analysis revealed that cis and transgender women had higher median fundamental frequency (fo) values than other genders. Cisgender women exhibited greater breathiness, while cisgender men showed more vocal quality deviations. In terms of APA, significant differences were observed among judge groups: SLP judged vowel samples differently from other groups, and TNB judged speech samples differently (both p<0.001). The predictive measures for the APA varied based on the sample type, speaker gender, and judge group. For vowel samples, only SLP judges had predictive measures (fo and ABI Jitter) for cisgender speakers. In number counting samples, predictive measures for cisgender speakers included fomed and HNR for CG judges, and fomed for both SLP and TNB judges. For transgender and non-binary speakers, predictive measures were fomed for CG and SLP judges, and fomed, CPPs, and ABI for TNB judges. In the poem recital task, predictive measures for cisgender speakers were fomed and HNR for both SLP and CG judges, with additional measures of cvint and sr for CG judges, and fomed, HNR, cvint, and fopeakwidth for TNB judges. For transgender and non-binary speakers, the predictive measures included a wider range of acoustic features such as fomed, fosd, sr, fomin, emph, HNR, Shimmer, and fo peakwidth for SLP judges, and fomed, fosd, sr, fomax, emph, HNR, and Shimmer for CG judges, while TNB judges considered fomed, sr, emph, fosd, Shimmer, HNR, Jitter, and fomax. There is an association between the perception of gender presentation in the voice and the gender or context of the listener and the speaker. Transgender and non-binary judges diverged to a higher degree from cisgender and SLP judges. Compared to the evaluation of cisgender speakers, all judge groups used a greater number of acoustic measurements when analyzing the speech of transgender and non-binary individuals in the poem recital samples.

Ethical considerations for non-procreative uterus transplantation.

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its 'success'), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this-the treatment of uterine infertility-explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both cis- and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non-procreative motivations for uterus acquisition ought to be taken seriously as a matter of non-discrimination and consistency.

Neighborhoods, Networks, and HIV Care Among Men Who Have Sex With Men: Proposal for a Longitudinal Study.

The majority of people living with HIV in the United States are men who have sex with men (MSM), with race- and ethnicity-based disparities in HIV rates and care continuum. In order to uncover the neighborhood- and network-involved pathways that produce HIV care outcome disparities, systematic, theory-based investigation of the specific and intersecting neighborhood and social network characteristics that relate to the HIV care continuum must be engaged. Using socioecological and intersectional conceptual frameworks, we aim to identify individual-, neighborhood-, and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and antiretroviral adherence) among MSM living with HIV in New York City. In the longitudinal cohort study, we assess 3 neighborhoods of potential influence (residential, social, and health care access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (eg, concentrated poverty and racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (eg, crime rates and housing vacancy); (2) alcohol and other drug use; (3) social norms (eg, homophobia and HIV stigma); and (4) community resources (eg, social services and public transit access). We test theoretical pathways of influence, including stress or coping, stigma or resilience, and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit, we locate each participant's reported activity spaces (ie, neighborhoods of potential influence) and collect individual-level data on relevant covariates (including perceptions of or exposure to neighborhoods) and social network inventory data on the composition, social support, and perceived social norms. The outcomes are HIV viral suppression, retention in care, and antiretroviral adherence. These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multilevel modeling are used to test the main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time. The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The median age was 44.1 (SD 11.5) years. Almost all participants self-identified as cisgender men (n=313, 98.1%) and as gay, homosexual, or bisexual (n=301, 94.4%). Overall, 192 (60.1%) participants identified as non-Hispanic Black, and 81 (25.3%) identified as Hispanic. Most (n=201, 63%) reported at least occasional difficulty in meeting basic needs (eg, rent and food) in the past 6 months. The mean number of years living with HIV was 15.4 (SD 10.1). This study will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas. PRR1-10.2196/64358.

Abstract 4137559: Assessing Veterans’ Risk of Cardiovascular Disease by Gender Identity

Background: Extant literature suggests that transgender and gender diverse (TGD) individuals experience a higher burden of CVD risk factors and psychosocial stressors than their cisgender (cis) peers. However, prior studies have been limited by self-reported outcomes or small samples. Aim: To determine whether TGD veterans have greater CVD (MI, ischemic stroke, cardiac revascularization) incidence than cis veterans using large, nationwide data. Methods: We used EHR data from the Veterans Healthcare Administration to identify veterans with &gt;2 outpatient encounters in fiscal years 2010-2019. Veterans’ gender identity was classified using natural language processing in combination with gender-affirming hormone therapy (GAHT) and a previously validated algorithm for identifying TGD individuals using ICD codes and VHA data. Of 1,105,082 veterans without prior CVD, 42,149 were classified as TGD. We examined sample characteristics by gender identity and used Cox regression to assess the association of gender identity with incident CVD. Results: TGD veterans’ mean age (years) was 46 (cis females=40; cis males=53). Cis females had the fewest CVD risk factors, followed by TGD veterans and cis males. Adjusting for age, race, and Hispanic ethnicity, TGD veterans had 1.49 [1.42-1.56] and 0.93 [0.90-0.97] times the risk of CVD compared to cis females and cis males, respectively. Upon additional adjustment for other CVD risk factors, renal function, alcohol use disorder, depression, anxiety, and sexual minority status, results remained statistically significant. Significance also held in sensitivity analyses which matched each TGD veteran to cis female and male veterans on age within 2 years. In analyses stratified by gender identity, trans feminine (HR [95% CI]: 1.26 [1.14-1.40]) and uncategorized TGD veterans (HR [95% CI]: 1.29 [1.22-1.37]) were at higher CVD risk than cis female veterans; trans masculine (HR [95% CI]: 0.85 [0.77-0.93]) and trans feminine veterans (HR [95% CI]: 0.90 [0.82-0.99]) were at lower CVD risk than cis male veterans. Among TGD veterans, GAHT receipt was associated with an 11% decrease in CVD risk. Conclusion: TGD veterans’, particularly trans feminine and uncategorized TGD veterans’, CVD risk was greater than that of cis females. Contrary to prior findings, GAHT was associated with decreased CVD risk. These results invite further study into the mechanisms by which GAHT and other factors impact CV health across and within gender identities.

The Role of Intersectional Stigma in Coronary Artery Disease Among Cisgender Women Aging with HIV

Cisgender women living with HIV experience elevated cardiovascular disease (CVD) risk that increases with age, a concern given extended life expectancies for people living with HIV. The CVD risk disparity among cisgender women aging with HIV is understudied and remains unclear. Taking a psychoneuroimmunology approach, given this group’s intersecting marginalized identities, one potential driver of the disparity is intersectional stigma. Yet not all women living with HIV have coronary artery disease (CAD). Resilience to stigma may serve as a protective factor to CAD, as observed in other health issues. This study aimed to explore the relationship between intersectional stigma, resilience, “traditional” CVD risk factors, and objective indicators of CAD among women aging with HIV. A diverse sample of cisgender women aging with HIV (aged ≥ 35, N = 48) completed a cross-sectional survey, clinical health interview, blood sample, blood pressure, anthropometric measurements, and computed tomography angiography (CTA). CART-based machine learning models assessed the statistical importance of traditional CVD risk factors, intersectional stigma, and resilience for classifying individuals with coronary artery stenosis, calcification, and inflammatory markers associated with CAD. Of the n = 31 who completed CTA, 74% had detectable calcification and 39% stenosis. Intersectional stigma was identified as an important variable for explaining calcification, but not stenosis, and for explaining sCD163, an inflammatory biomarker associated with CAD. Results show a potential psychoneuroimmunology pathway to the CAD disparity among this group. Future longitudinal research should investigate the mechanisms of this pathway and consider stigma as target for intervention to improve cardiovascular health among women aging with HIV.

Refinements in Gender-Affirming Feminizing Chest Surgery.

Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery. A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery. Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery. Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.

Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review.

Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb. PRR1-10.2196/57931.

“Transgenders are not dinosaurs!” Stigma faced by transgender women in their daily lives in India: implications for research and policy

Background Transgender women face stigma that adversely impacts their mental wellbeing. The stigma can be self-directed (internal), discrimination, violence and hatred directed towards them by others, mostly cis-gender persons (interpersonal stigma) and discrimination faced at the level of institutional arrangements (structural stigma). Methods This was an exploratory study that used qualitative methods of data collection (focused group discussions and in-depth interviews) to gather data from consenting adult trans women who lived in the city of Kolkata situated in the eastern state of West Bengal in India. Results The findings showed that trans women faced the trauma of non-acceptance and even rejection by their families when they began to express their chosen gender. Their gender non-conforming behaviour made them the butt of ridicule and harassment in school, resulting in many of them not finishing school. This made finding employment difficult. The trans women study participants also faced harassment at the hands of the police and from hospital staff, making them reluctant to approach the police for help and seek treatment from health providers for their physical as well as mental health concerns. Conclusions It is important for researchers to be cognizant of the challenges faced by trans women/transgender people while designing and conducting research. It is also important for policymakers to make gender affirming policies to mitigate and eliminate the stigma that transgender people are subject to thereby promoting their wellbeing.

Intersectionality in Health Communication: How Health Communication Influences the Association Between Intersectional Discrimination and Health Information Seeking

With an intersectional orientation, we examine associations between discrimination, health communication, and information-seeking intention about HIV prevention in the context of pre-exposure prophylaxis (PrEP) among cisgender women through an online survey (N = 341). We elaborate on the idea that intersectional discrimination is a social determinant of health by considering the context with differing power relations—day-to-day life and the healthcare field—based on Bourdieu’s field theory, and explore moderating roles of health communication in this relationship according to the structural influence model of communication (SIM). The relationships between intersectional discrimination and intention show different patterns by the context in which intersectional experiences are considered, and the relationships are moderated differently by the mode of health communication. We discuss how to conduct intersectionality-informed health communication research without sacrificing intersectionality’s foundational foci.

Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients.

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Housing insecurity and government housing support utilization among a nationally representative sample of transgender and gender non-conforming adults

ABSTRACT Transgender and gender non-conforming (TGNC) individuals experience greater social adversity and negative social determinants of health compared to cisgender people. This study explored housing security and service use within a probability-based, nationally representative sample. Respondents were adults (264 TGNC; 23,096 cisgender) from the U.S. Federal Reserve Survey of Household Economics and Decision-making. Chi-square and multiple logistic regression analyses compared differences between TGNC and cisgender respondents for housing security indicators and government housing support use. Multivariable analyses were weighted for complex sampling design. Despite a large proportion of TGNC respondents reporting inability to pay their bills (27.9%) and not being homeowners (62.0%), utilization rates for government housing assistance were low (10.4%). Adjusting for covariates, TGNC respondents had significantly greater odds of reporting governmental housing assistance (aOR = 2.64, 95%CI = 1.52–4.60) than cisgender respondents. There was no difference in ability to pay bills or homeownership. Findings indicate that government housing services are reaching TGNC adults relative to cisgender results, but utilization rates remain low despite indicators of high need. Factors influencing utilization and efficacy of services should be assessed in future research to support policy implementation.

Increasing engagement in HIV prevention among cisgender women in New York City with sexual health self-testing kits: A MaxDiff analysis.

Despite accounting for approximately 20% of new HIV diagnoses in the United States, cisgender women are consistently under-represented and under-engaged in HIV prevention services such as HIV testing and pre-exposure prophylaxis (PrEP). Black and Latina cisgender woman (BLCW) are disproportionately impacted by HIV, and face additional barriers to accessing prevention services due to racial/ethnic bias, sexism, and their intersection. Offering self-testing for sexually transmitted infections (STIs) and HIV is one potential strategy for increasing access to-and engagement in-preventative sexual health care among BLCW. We conducted a study in consultation with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and their collaborators in order to identify preferences for sexual health kits-including HIV and STI tests-among BLCW in New York City. We assessed the extent to which BLCW would be willing to accept and use HIV and STI self-testing. Additionally, we identified the components of potential sexual health kits that would make them most attractive and would most increase the reach of a sexual health kit program in NYC. Finally, we examined differences in acceptability and preferences (by demographic factors, sexual behavior, and past service utilization) that may impact the development of future programs and interventions. Self-testing for STIs and HIV represents a promising strategy for engaging BLCW in preventative sexual health services and increasing access to care.

A Cross Community Comparison of Muting in Conversations of Gendered Violence on Reddit

Gender-based violence (GBV) is an ongoing public health issue. Prevention practice and research on GBV contend with an incomplete understanding of its public health burden due to gender-exclusive definitions of GBV and inhibited survivor disclosure. Prior work in CSCW and HCI has explored sensitive disclosures and GBV conversations but excludes examination of conversation dynamics in surfacing knowledge of GBV. We used a mixed-methods approach to understand the phenomenon characterized by Muted Group Theory as a mechanism inhibiting disclosure in the context of GBV discussions on Reddit. Using an iterative process informed by literature of GBV research on cis-gender women, girls, trans, and non-binary populations, we developed comprehensive keywords to obtain, annotate, and analyze 298 posts and 10,369 comments about GBV across 7 subreddits. We found that muting faced by survivors offline, precluding reporting, is replicated on the Reddit platform. This study surfaced 5 categories of muting in discussions of GBV situated by variations in communication norms between dominant and non-dominant groups. These findings were supported by analysis of linguistic attributes that inform an Ensemble Classifier's detection of muting in conversations of GBV. The results offer that muting is a harmful occurrence in online disclosures of GBV that is mediated by existing moderation practices. This work contributes an expanded understanding of GBV conversations online, muting as a feature of those conversations, and an initial foray into detection to inform muting prevention.

Paradoxes of Openness: Trans Experiences in Open Source Software

In recent years, concerns have increased over the lack of contributor diversity in open source software (OSS), despite its status as a paragon of open collaboration. OSS is an important form of digital infrastructure and part of a career path for many developers. While there exists a growing body of literature on cisgender women's under-representation in OSS, the experiences of contributors from other marginalized groups are comparatively absent from the literature. Such is the case for trans contributors, a historically influential group in OSS. In this study, we interviewed 21 trans participants to understand and represent their experiences in the OSS literature. From their experiences, we theorize two related paradoxes of openness in OSS: the paradox of openness and display and the paradox of openness and governance. In an increasingly violent world for trans people, we draw on our theorizing to build recommendations for more inclusive and safer OSS projects for contributors.

Cancer disparities by age: a focus on sexual and gender minorities.

The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals. We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents. Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women. These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.

Impulsivity Moderates the Association Between Hazardous Alcohol Use and Risky Sexual Behaviors Among Cisgender Bisexual Women

Bisexual women report higher rates of alcohol use and risky sexual behavior than lesbian and heterosexual women. Impulsivity (i.e., action without considering negative consequences) is a risk factor for greater alcohol use and sexual behavior, but few studies have examined the impact of impulsivity on alcohol use and sexual behavior among cisgender bisexual women. Consequently, the purpose of this study was to examine the moderating role of impulsivity on the association between hazardous alcohol use and sexual risk-taking among cisgender bisexual emerging adults. Participants were 225 self-identified cisgender bisexual women (Ma ge = 22.77, SD = 3.45) who completed an online survey about their hazardous alcohol use using the Alcohol Use Disorder Identification Test (AUDIT), impulsivity, and sexual behaviors over the past 30 days. A moderated regression model examined main effects of impulsivity and alcohol use severity, and their interaction, on sexual risk-taking. The association between alcohol use severity and sexual risk-taking was moderated by impulsivity. Simple slopes analyses revealed that greater alcohol use severity was associated with greater sexual risk-taking, but this only occurred for participants with average or high scores of impulsivity. These results suggest prevention programs that target alcohol use should address the role that impulsivity may have on risky sexual behaviors among young bisexual women. Future research would benefit from looking at various outcomes related to sexual risk to determine which are most predominantly associated with alcohol use severity and impulsivity.

Kidney disease and reproductive health.

Understanding the relationship between reproductive health and kidney function is important to provide holistic care for people living with kidney disease. Chronic kidney disease (CKD) has negative impacts on both male and female fertility owing to factors including inflammation, hormonal dysregulation, reduced ovarian reserve, reduced sperm quality and sexual dysfunction. However, pregnancy is achievable for most cisgender women with kidney disease, including kidney transplant recipients and patients on dialysis. CKD in pregnancy is associated with health risks to the mother and child, including increased risk of progression of kidney disease, hypertensive complications of pregnancy, and neonatal complications including fetal growth restriction, preterm birth and stillbirth. However, with appropriate pre-pregnancy counselling, fertility assessment and support, health optimization, and evidence-based antenatal care, the majority of patients will achieve a good outcome. Medication safety should be reviewed before and during pregnancy and lactation, weighing the risk of disease flare against potential adverse effects on the offspring. Important areas for further research include the optimal timing of delivery and the short- and long-term cardiovascular and renal impacts of pregnancy in patients with CKD, as well as long-term kidney and cardiovascular outcomes in their offspring.