Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in:

Open Access 01-12-2024 | Research

‘Taking it one day at a time’ and ‘Reaching back out to help someone’: How transgender women living with HIV and community stakeholders navigate violence, oppression, and health through coping and advocacy

Authors: Sannisha K. Dale, Peyton R. Willie, Ethel Kirabo Nalule, Camille Lewis, Summer Heard, Nadine Gardner, Chelsie Warman, Kirk Palmer, Belita Wyatt, Phara Benoit

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Transgender women living with HIV face intersectional oppression resulting in consequences for their mental and physical health. Interventions are needed that center the voices of transgender women living with HIV (TWLWH) and community stakeholders engrossed in work on behalf of the transgender community through advocacy and/or work roles.

Methods

Through a partnership with a trans led and focused program of a community-based health organization and an academic partner, from October 2020 through October 2021, TWLWH and community stakeholders participated in qualitative interviews on trauma, violence, mental health struggles, HIV stigma, gender discrimination, health behaviors (e.g., medication adherence), and their thoughts and recommendations for a proposed intervention. Using a virtual platform (i.e., Zoom or phone) TWLWH and stakeholders were administered a demographics survey via Research Electronic Data Capture (REDCap) and completed individual interviews that were audio recorded. These interviews were analyzed using thematic content analysis.

Results

All TWLWH and 50% of stakeholders were Black. Qualitative findings highlighted the magnitude of violence, stigma, and discrimination faced by TWLWH and the mental, physical, and economic consequences. Also highlighted were the adaptive strategies TWLWH are utilizing to cope, ways in which invested stakeholders (many of lived expertise) are showing up for women, and acceptability and valuable insights for a proposed intervention.

Conclusion

TWLWH are navigating a hostile society and multilevel interventions (at the structural, community, interpersonal, and individual levels) centering their voices and those invested in advocating for the community are needed to address the sequelae of oppression they face.
Appendix
Available only for authorised users
Literature
1.
Budhwani H, Hearld KR, Milner AN, Charow R, McGlaughlin EM, Rodriguez-Lauzurique M, et al. Transgender women’s experiences with Stigma, Trauma, and attempted suicide in the Dominican Republic. Suicide Life Threat Behav. 2018;48(6):788–96.PubMedCrossRef
2.
Klemmer CL, Arayasirikul S, Raymond HF. Transphobia-based violence, Depression, and anxiety in Transgender women: the role of body satisfaction. J Interpers Violence. 2021;36(5–6):2633–55.PubMedCrossRef
3.
Lenning E, Brightman S, Buist CL. The trifecta of violence: a Socio-Historical Comparison of Lynching and violence against Transgender Women. Crit Criminol. 2021;29(1):151–72.CrossRef
4.
5.
Lindsay JA, Keo-Meier C, Hudson S, Walder A, Martin LA, Kauth MR. Mental Health of Transgender veterans of the Iraq and Afghanistan conflicts who experienced military sexual trauma: MST and Mental Health of Transgender Veterans. J Trauma Stress. 2016;29(6):563–7.PubMedCrossRef
6.
Mizock L, Lewis T. Trauma in Transgender populations: risk, resilience, and Clinical Care. J Emot Abuse. 2008;8(3):335–54.CrossRef
7.
Nadal KL, Davidoff KC, Fujii-Doe W. Transgender women and the sex work industry: roots in systemic, institutional, and interpersonal discrimination. J Trauma Dissociation. 2014;15(2):169–83.PubMedCrossRef
8.
Richmond KA, Burnes T, Carroll K. Lost in trans-lation: interpreting systems of trauma for transgender clients. Traumatology. 2012;18(1):45–57.CrossRef
9.
Marcellin RL, Bauer GR, Scheim AI. Intersecting impacts of transphobia and racism on HIV risk among trans persons of colour in Ontario, Canada. Carol Mutch and Dr Jay Marlowe D, editor. Ethn Inequalities Health Soc Care. 2013;6(4):97–107.CrossRef
10.
Reisner SL, Chaudhry A, Cooney E, Garrison-Desany H, Juarez-Chavez E, Wirtz AL. It all dials back to safety’: a qualitative study of social and economic vulnerabilities among transgender women participating in HIV research in the USA. BMJ Open. 2020;10(1):e029852.PubMedPubMedCentralCrossRef
11.
Salazar LF, Crosby RA, Jones J, Kota K, Hill B, Masyn KE. Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia. Int J STD AIDS. 2017;28(11):1059–66.PubMedCrossRef
12.
13.
Crenshaw KW. Mapping the margins: intersectionality, identity politics, and violence against women of color. In: Stanford Law Rev. 1991. pp. 1249–99.
14.
Bowleg L. The Problem with the phrase women and minorities: Intersectionality—an important theoretical Framework for Public Health. Am J Public Health. 2012;102(7):1267–73.PubMedPubMedCentralCrossRef
15.
Guy-Sheftall B. Words of fire: an anthology of African-American Feminist Thought. New York: New York; 1995.
16.
Blackpast B. The Combahee River Collective Statement.BlackPast.org. 2012.
17.
18.
Berger MT. Coining Intersectional Stigma: historical erasures and the future. Am J Public Health. 2022;122(4):S338–9.CrossRef
19.
Berger MT. Workable sisterhood: the political journey of stigmatized women with HIV/AIDS. Princeton University Press; 2010.
20.
Klein PW, Psihopaidas D, Xavier J, Cohen SM. HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS program: a retrospective study. Geng EH, editor. PLOS Med. 2020;17(5):e1003125.PubMedPubMedCentralCrossRef
21.
Smith LR, Patel VV, Tsai AC, Mittal ML, Quinn K, Earnshaw VA, et al. Integrating intersectional and syndemic frameworks for ending the US HIV Epidemic. Am J Public Health. 2022;112(S4):S340–3.PubMedPubMedCentralCrossRef
22.
23.
Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-Serostatus, Race, and sexual orientation among African–American men with HIV. Ann Behav Med. 2010;40(2):184–90.PubMedCrossRef
24.
25.
Logie CH, Earnshaw VA, Nyblade L, Turan JM, Stangl A, Poteat T et al. A scoping review of the integration of empowerment-based perspectives in quantitative intersectional stigma research. Glob Public Health. 2021.
26.
Poteat T, Lett E, Rich AJ, Jiang H, Wirtz AL, Radix A, et al. Effects of race and gender classifications on atherosclerotic Cardiovascular Disease Risk estimates for clinical decision-making in a cohort of Black Transgender women. Health Equity. 2023;7(1):803–8.PubMedPubMedCentralCrossRef
27.
28.
LaMartine S, Nakamura N, Garcia J. Even the officers are in on it: black Transgender women’s experiences of Violence and victimization in Los Angeles. Women Ther. 2023;46(2):103–29.CrossRef
29.
30.
Hou J, Fu J, Meng S, Jiang T, Guo C, Wu H, et al. Posttraumatic stress disorder and Nonadherence to treatment in people living with HIV: a systematic review and Meta-analysis. Front Psychiatry. 2020;11:834.PubMedPubMedCentralCrossRef
31.
Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, et al. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med. 2021;44(2):147–58.PubMedCrossRef
32.
Patrick J, Dale SK. Mental Health, Self-Care, and Engagement in Care among Black women living with HIV. Ethn Dis. 2023;33(2–3):116–23.PubMedCrossRef
33.
34.
Poteat T, Wirtz AL, Radix A, Borquez A, Silva-Santisteban A, Deutsch MB, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86.PubMedCrossRef
35.
Lacombe-Duncan A, Logie CH, Newman PA, Bauer GR, Kazemi M. A qualitative study of resilience among transgender women living with HIV in response to stigma in healthcare. AIDS Care. 2020;32(8):1008–13.PubMedCrossRef
36.
Heng A, Heal C, Banks J, Preston R. Transgender peoples’ experiences and perspectives about general healthcare: a systematic review. Int J Transgenderism. 2018;19(4):359–78.CrossRef
37.
Sevelius JM, Neilands TB, Dilworth S, Castro D, Johnson MO. Sheroes: feasibility and acceptability of a Community-Driven, Group-Level HIV intervention program for Transgender Women. AIDS Behav. 2020;24(5):1551–9.PubMedPubMedCentralCrossRef
38.
39.
40.
41.
Mezey SG. Transgender Policymaking: the View from the States. Publius J Fed. 2020;50(3):494–517.CrossRef
42.
Arayasirikul S, Turner C, Trujillo D, Sicro SL, Scheer S, McFarland W, et al. A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care. Int J Equity Health. 2022;21(1):32.PubMedPubMedCentralCrossRef
43.
Sherman ADF, Allgood S, Alexander KA, Klepper M, Balthazar MS, Hill M, et al. Transgender and gender Diverse Community connection, Help-Seeking, and Mental Health among Black Transgender women who have survived violence: a mixed-methods analysis. Violence Women. 2022;28(3–4):890–921.CrossRef
44.
El-Khodary B, Samara M. The relationship between multiple exposures to violence and war trauma, and mental health and behavioural problems among Palestinian children and adolescents. Eur Child Adolesc Psychiatry. 2020;29(5):719–31.PubMedCrossRef
45.
Jefferson K, Neilands B, Sevelius T. J. Transgender women of color: discrimination and depression symptoms. Carol Mutch And Dr Jay Marlowe D, editor. Ethn Inequalities Health Soc Care. 2013;6(4):121–36.
46.
Sherman ADF, Poteat TC, Budhathoki C, Kelly U, Clark KD, Campbell JC. Association of Depression and post-traumatic stress with polyvictimization and emotional transgender and gender Diverse Community connection among Black and Latinx Transgender women. LGBT Health. 2020;7(7):358–66.PubMedCrossRef
47.
Boga DJ, Dale SK. Black women living with HIV: A Latent Profile Analysis of Intersectional adversities, Resilience, and Mental Health. AIDS Patient Care STDs. 2022;36(9):364–74.PubMedPubMedCentralCrossRef
48.
Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, et al. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol off J Div Health Psychol Am Psychol Assoc. 2023;42(5):299–313.
49.
Dale SK, Safren SA. Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among black women living with HIV. Psychol Trauma Theory Res Pract Policy. 2019;11(7):685–94.CrossRef
50.
Brightman S, Lenning E, Lurie KJ, DeJong C. Anti-transgender ideology, laws, and Homicide: an analysis of the trifecta of violence. Homicide Stud. 2023;10887679231201803.
51.
Bockting W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and Retention in HIV Care for Transgender women: perspectives of Medical and Social Service Providers in New York City. AIDS Patient Care STDs. 2020;34(1):16–26.PubMedPubMedCentralCrossRef
52.
Dale SK, Safren SA. Resilience takes a village: black women utilize support from their community to foster resilience against multiple adversities. AIDS Care. 2018;30(sup5):S18–26.PubMedCrossRef
53.
Lacombe-Duncan A, Bauer GR, Logie CH, Newman PA, Shokoohi M, Kay ES, et al. The HIV Care Cascade among Transgender Women with HIV in Canada: a mixed-methods study. AIDS Patient Care STDs. 2019;33(7):308–22.PubMedCrossRef
54.
Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, et al. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care. 2021;33(1):31–8.PubMedCrossRef
55.
Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, et al. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care. 2023;35(4):572–80.PubMedCrossRef
56.
Rosen JG, Malik M, Cooney EE, Wirtz AL, Yamanis T, Lujan M, et al. Antiretroviral Treatment Interruptions among Black and Latina Transgender Women Living with HIV: characterizing co-occurring, multilevel factors using the gender affirmation Framework. AIDS Behav. 2019;23(9):2588–99.PubMedPubMedCentralCrossRef
57.
Yarbrough D. The carceral production of transgender poverty: how racialized gender policing deprives transgender women of housing and safety. Punishm Soc. 2023;25(1):141–61.CrossRef
58.
59.
60.
Guest G, Bunce A, Johnson L. How many interviews are Enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef
61.
Connolly DJ, Muschialli L. A call to action for equitable care for trans and non-binary people. Lancet. 2024;403(10422):139–40.PubMedCrossRef
62.
63.
Person AK, Terndrup CP, Jain MK, Kelley CF. Do we stay or do we go? The impact of Anti-LGBTQ + legislation on the HIV workforce in the South. Clin Infect Dis. 2024;78(2):411–3.PubMedCrossRef
64.
65.
King WM, Jadwin-Cakmak L, Trammell R, Gamarel KE. Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit. Cult Health Sex. 2023;25(6):681–97.PubMedCrossRef
66.
67.
Metadata
Title
‘Taking it one day at a time’ and ‘Reaching back out to help someone’: How transgender women living with HIV and community stakeholders navigate violence, oppression, and health through coping and advocacy
Authors
Sannisha K. Dale
Peyton R. Willie
Ethel Kirabo Nalule
Camille Lewis
Summer Heard
Nadine Gardner
Chelsie Warman
Kirk Palmer
Belita Wyatt
Phara Benoit
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-20717-0

Other articles of this Issue 1/2024

The sex difference in self-rated health among older Turkish and Moroccan migrants in the Netherlands: an exploratory study of contributing determinants

  • Open Access
  • Research

Association of the visceral fat metabolic score with osteoarthritis risk: a cross-sectional study from NHANES 2009–2018

  • Open Access
  • Research

The perceived experience of adhering to vegan diet: a descriptive phenomenological study

  • Open Access
  • Research

Association of anthropometric measures with all-cause and cause-specific mortality in US adults: revisiting the obesity paradox

Insulin resistance and sarcopenia: a prognostic longitudinal link to stroke risk in middle-aged and elderly Chinese population

Immune Dysregulation in SARS-CoV-2 patients coinfected with Mycobacterium tuberculosis (Mtb) or HIV in China