Gender Affirmative Model Research Articles

A Gender Affirmative Model of Training and Service Provision Among HIV Service Organizations in the U.S. South.

Data were collected from Southern HSOs (n=207). Relations between GAM training and service provision were examined through frequency distributions and logistic regressions. Few (46.6%) received training. Most (73%) used clients' asserted names and pronouns. Only 62% engaged with transgender, nonbinary, and gender nonconforming (TGNC) communities and 55% provided a gender autonomous (i.e., based on self-determination) facility. Gender affirmative model-trained HSOs had at least twice the odds of implementing GAM elements compared with non-trained HSOs. Barriers included funding (61%), expertise/knowledge (59%), capacity/staff-ing (52%), and political climate (23%). This study identifies gaps and highlights the urgent need for funding, training, and meaningful TGNC community partnerships.

A Qualitative Examination of Tobacco Use and Smoking Cessation Among Gender Minority Adults.

Despite the elevated prevalence of smoking among gender minority adults, little is known about the factors that influence their tobacco use and cessation. We identified and examined factors that influence tobacco use and cessation for gender minority adults, using a conceptual framework based on the Model of Gender Affirmation and Gender Minority Stress Model. Nineteen qualitative, semi-structured in-depth interviews were conducted with gender minority adults who smoke or no longer smoke and were recruited from the Portland, OR metropolitan area. Interviews were audio-recorded, professionally transcribed, and analyzed utilizing thematic analysis. Four main themes were generated. Gender minority adults smoke to cope with general and gender minority-specific stressors. Smoking was described as a social behavior that was influenced and sustained by community and interpersonal relationships. Smoking cessation was motivated by health concerns (both general and gender minority-specific) and moderated by conducive life circumstances. Recommendations for tobacco cessation interventions highlighted the importance and role of social support. Participants expressed a strong desire for gender minority-specific tobacco cessation programs. There are unique and complex factors that contribute to the higher prevalence of smoking observed among gender minority adults. Tobacco cessation interventions are urgently needed for this population and should be tailored to address the unique factors that impact tobacco use and cessation among gender minority people to increase the likelihood of success.

Gender Affirmation through Correct Pronoun Usage: Development and Validation of the Transgender Women's Importance of Pronouns (TW-IP) Scale.

Social interactions where a person is addressed by their correct name and pronouns, consistent with their gender identity, are widely recognized as a basic and yet critical aspect of gender affirmation for transgender people. Informed by the Model of Gender Affirmation, we developed a self-report measure of the importance of social gender affirmation, the Transgender Women’s Importance of Pronouns (TW-IP) scale, which measures gender affirmation through the usage of correct pronoun by others. Data were from self-administered surveys in two independent samples of transgender women living with HIV in the US (N1 = 278; N2 = 369). Using exploratory factor analysis with data from Study 1 and confirmatory factor analysis with data from Study 2, we obtained a four-item scale with a single-factor structure and strong reliability (α = 0.95). We present evidence of TW-IP’s convergent and discriminant validity through its correlations with select mental health and HIV-related measures. Further, scores on TW-IP were linked in expected directions to several hypothesized mental health and HIV care outcomes, demonstrating its predictive validity. The resulting brief measure of importance of pronouns among transgender women shows strong psychometric properties. Validation evidence offers highly promising opportunities for use of the measure in clinical and research settings.

Restricting the Gendered Body: Understanding the Trans-masculine Adolescent with Anorexia

In recent years, researchers discovered that transgender and gender expansive (TGE) individuals had elevated rates of eating disorders when compared with their cisgender peers. TGE clients experience an increased risk for developing eating disorders due to co-occurring gender dysphoria and trauma from gender minority stressors. An inspection of the literature reveals a gap when searching for the trans-masculine adolescent experience of eating disorder treatment, including nominal research targeting TGE clients with eating disorders and minimal exploration of treating these phenomena concurrently. Gender dysphoria creates unique challenges to body image, prompting some TGE clients to use eating disorder behaviors to change their bodies. Gender minority stressors, such as gender-based victimization and identity non-affirmation, increase vulnerability to identity-based traumas. As eating disorder behaviors can be used to cope with trauma, TGE clients are at further risk when experiencing co-occurring identity-based trauma and gender dysphoria. This composite case study seeks to contribute to the literature by providing a description of the therapy provided over the course of two years with a trans-masculine adolescent using restrictive behaviors to change his body to alleviate symptoms of gender dysphoria, as well as to numb against identity-based traumas. Interventions across each treatment phase are grounded in the gender affirmative model, suggesting opportunities to expand this approach to serve TGE clients in traditional eating disorder and trauma therapy.

Book Review: The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children

Book Review: The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV.

Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.

Optimising HIV programming for transgender women in Brazil

In Brazil, little data is available to inform HIV prevention programming for travestis and transgender (‘trans’) women, despite the existence of a social movement that has gained strength in recent years. We conducted formative research in Rio de Janeiro to gather trans women’s perspectives on combination HIV prevention approaches. Framing the analysis within the model of gender affirmation, we found that several social and contextual factors inhibited participants’ access to HIV prevention and treatment. Experienced and anticipated gender-related discrimination and HIV stigma were linked to the avoidance of HIV testing, health services and HIV status disclosure. Participants recommended HIV prevention interventions which combined socio-structural interventions, such as peer-based empowerment and social support, with biomedical interventions such as pre-exposure prophylaxis (PrEP). Participants expressed a preference for programmes and interventions that emphasised a gender-affirmative approach, promoted autonomy and aimed to reduce stigma and discrimination in public health services.

ETHICS IN CHILD AND YOUTH CARE PRACTICE WITH TRANSGENDER YOUTH

Issues that arise in child and youth care practice with transgender (trans) youth and their families can be complex and ethically challenging. While many trans youth are thriving and have strong family and social supports, others face family conflict and experience negative health outcomes linked to societal stigma. The purpose of this paper is to explore how four ethical approaches — bioethics, rights-based ethics, relational ethics, and justice-doing — may be applied to practice situations involving trans youth and their families. This paper is grounded in the gender affirmative model of care and integrates empirical evidence, critical thinking, and explicit argumentation in ethical analysis. Following a brief overview of evidence related to trans youth care, case vignettes are analyzed using diverse ethical approaches. These approaches draw on a variety of philosophical and disciplinary traditions. However, the analyses consistently lead to three imperatives: providing support and affirmation for trans youth; supporting families to support their youth; and fighting injustice where it impedes these goals.

Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care.

Heightened public awareness about gender diversity in childhood and adolescence has resulted in more youth and families seeking medical and mental health services. In response to these needs, there has been nationwide growth in specialized multidisciplinary clinics treating gender-diverse and transgender youth. Despite general agreement that comprehensive treatment is best delivered through a multidisciplinary team by both medical and mental health clinicians with gender-related expertise and familiarity with child and adolescent development, there is currently no consensus regarding the best approach to clinical care with gender-diverse and transgender youth. In this article, we provide a narrative review of the gender affirmative model guiding our clinical practice and describe the development of our unique model of affirming care within the Gender and Sex Development Program at the Ann & Robert H. Lurie Children's Hospital of Chicago.

Found in Transition: Our Littlest Transgender People

An increasing number of children are coming with their parents to seek out mental-health services as they explore, question, or give voice to their gender concerns. This article presents a particular orientation of practice to help those children, the gender affirmative model, proposing that psychoanalytic practitioners are ideally situated to help these children within this approach, using techniques of listening, mirroring, suspension in psychic intermediate spaces, play, and interpretation. Concepts of the true gender self, false gender self, and gender creativity are presented. Particular attention is paid to prepubertal children who affirm that their gender does not match the sex listed on their birth certificate, and examines the question of whether it is in the best interests of these children to allow them to socially transition to the gender they affirm themselves to be. A case example is presented of a five-year-old exploring gender to demonstrate the gender affirmative clinical approach in a psychoanalytic context.