BACKGROUND: Transgender women suffer a great deal of self-reported anxiety and concern about their facial appearance as they may readily be identified by observers as "trans" when they would prefer to be interpreted solely as women. Little is known about the psychological distress that transgender individuals experience in their decision to undergo major aesthetic plastic surgery as a result of their appearance concern. As such, it remains unknown whether transgender individuals experience improved appearance anxiety and a greater quality of life following facial feminization surgery. AIMS: The objective of this study is to determine, using the Derriford Appearance Scale 24, whether any improvement can be seen among transgender patients in their level of appearance anxiety following facial feminization surgery. We also aim to look at whether additional improvements can be seen in the quality of life of transgender patients. METHODS: A prospective study was conducted on patients undergoing facial feminization surgery. The outcome measure used was the Derriford Appearance Scale 24. The Derriford Appearance Scale 24 was given to transgender patients to fill out at the end of their pre-operative visit before their schedule facial feminization surgery. The scale was then also administered three weeks following surgery and three months following surgery, via the Internet. RESULTS: Twenty-four patients were enrolled. Of these, fourteen patients completed at least one of the surveys, post-operatively; twelve patients completed all three surveys. Of those patients who completed at least two out of the three surveys, scores revealed that 85% of transgender patients displayed higher levels of psychological distress when completing the first survey, preoperatively, than in subsequent post-operative surveys. CONCLUSIONS: Transgender individuals enrolled in the study showed decreased levels of distress both three weeks after surgery and three months after surgery. These results were promising in displaying amelioration of appearance anxiety following facial feminization surgery. Though results show increased quality of life, the degree of impact that gender confirming facial features may have on quality of life for transgender patients has yet to be assessed.

Background: Binge drinking (BD) is common in Peru, but may not be routinely detected by standard assessments of hazardous drinking. Objectives: We describe prevalence and risk behaviors of men who have sex with men (MSM) and transgender women (TW) in Peru who met criteria for BD as compared with those who met criteria for hazardous drinking. Methods: In a cross-sectional sample of MSM and TW from Lima (2012-2014), we calculated prevalence of BD (consuming ≥6 alcoholic drinks per occasion by AUDIT-3 criteria), conducted bivariate analyses of associations of BD with demographic and behavioral characteristics, and compared prevalence and behaviors of BD to those of hazardous drinkers (identified by AUDIT-10 criteria). Results: Of 1,520 MSM (n = 1,384) and TW (n = 137) with median age 27 years, 74.4% of MSM and 86.9% of TW met criteria for BD. Among MSM, BD was associated with a greater likelihood of using alcohol (41.6% vs. 13.8%; p <.01) or drugs (7.8% vs. 2.8%; p <.01) prior to a recent sexual contact. Among TW, BD was associated with greater frequency of alcohol use (44.9% vs. 11.1%; p <.01) or unprotected anal intercourse (58.8% vs. 33.3%; p =.04) during ≥1 of their three most recent sexual contacts. There was a higher prevalence of BD (75.5%) than hazardous drinking (53.2%) in our sample, with binge drinkers exhibiting similar sexual risk behaviors to hazardous drinkers. Conclusions: Binge drinking is common among MSM and TW in Lima, associated with risky sexual behavior, and may not be adequately captured by AUDIT-10 criteria. / Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging. / National Institutes of Health / Revisión por pares

Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation. / National Institutes of Health / Revisión por pares

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17–10.25, aPR 2.46, 95% CI 1.14–5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19–4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56–12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63–14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission. / amfAR, The Foundation for AIDS Research / Revisión por pares

In the United States, homelessness is often connected to traumatic events such as domestic violence, job loss, or post incarceration experiences, frequently resulting in substance use disorders, medical issues, and related mental illnesses. Although researchers have considered how homelessness and social service interventions affect sexual and gender minority youth, they have not adequately studied the causes and effects of homelessness among transgender women. The purpose of this interpretive phenomenological study was to bridge this gap in knowledge by exploring the experiences of chronically homeless transgender women. The research question focused on the lived experiences of chronically homeless transgender women who try to obtain social services from outreach workers. A purposive sample of 8 chronically homeless transgender women from the southeastern United States completed individual face-to-face interviews. Using phenomenological strategies, the narratives were analyzed and interpreted into codes, categories, and themes. Four central themes were identified, including reasons for homelessness, the lived experience of chronic homelessness, experiences related to transgender identity, and involvement with social services. Participants faced barriers with social services agencies and outreach workers, including administrative demand for binary gender classification, blatant ignorance and discrimination, and a lack of trans-positive treatment facilities and shelters. The findings and recommendations from this study may advance positive social change by guiding the efforts of social service agencies and outreach workers to improve the quality of social services for transgender women.

No description available.

No description available.

Estimativas mundiais apontam que 19% das travestis e mulheres trans estão vivendo com HIV/Aids; no Brasil, a prevalência está acima de 30%. Essas taxas são crescentes e expressam a falta de atenção à saúde desta população. Raros estudos abordam a adesão dessa população aos antirretrovirais, com resultados preocupantes demonstrando falhas na adesão; além disso, escassos trabalhos científicos descrevem a qualidade de vida de travestis e mulheres trans vivendo com HIV/Aids. Este estudo teve por objetivos: (i) descrever a adesão à terapia antirretroviral de travestis e mulheres trans vivendo com HIV/Aids; (ii) identificar fatores associados com a adesão à terapia antirretroviral; (iii) mensurar a qualidade de vida entre travestis e mulheres trans vivendo com HIV/Aids; (iv) identificar fatores associados à qualidade de vida; e (v) explorar a associação entre qualidade de vida e adesão à terapia. A ferramenta para estimar a adesão foi o autorrelato desenvolvido pelo grupo Terry Beirn Community Programs for Clinical Reserch on Aids, além do parâmetro clínico carga viral. Para avaliação da qualidade de vida o questionário utilizado foi o Patient Report Outcomes Quality of Life - HIV (PROQOL-HIV). Este estudo foi aprovado pelo comitê de ética e pesquisa da Faculdade de Medicina da Universidade de São Paulo - FMUSP e pelo comitê de ética e pesquisa do Centro de Referência e Treinamento CRT Santa Cruz, além de estar em consonância com as diretrizes da resolução nº 510 de 2016 pelo Conselho Nacional em Saúde. Os dados foram analisados no programa STATA 15.1, sendo aplicados teste qui-quadrado, teste da soma dos postos de Wilcoxon, cálculo da correlação não paramétrica de Spearman e modelo de regressão logística multivariada. Cento e seis travestis e mulheres trans vivendo com HIV/Aids foram incluídas nesse estudo, das quais 90% declararam adesão ao tratamento; idade mais avançada foi identificada como fator associado a melhor adesão. O escore de qualidade de vida esteve entre boa a excelente em cinco dos 8 domínios do PROQOL-HIV; e menor escolaridade, depressão e uso de drogas ilícitas foram fatores associados com pior escore de qualidade de vida. Não observamos correlação estatisticamente significante entre qualidade de vida e adesão. Nosso estudo sugere que os resultados obtidos possam estar relacionados ao modelo de atendimento adotado no centro recrutador. Estudos multicêntricos, com maior número de participantes e que considere unidades de atendimento localizadas em regiões remotas e menos favorecidas são necessários para expressar a real situação da adesão aos antirretrovirais e qualidade de vida de travestis e mulheres trans. / Worldwide estimates indicate that 19% of transgender women are living with HIV / AIDS; in Brazil, the prevalence is above 30%. The increase of the numbers express the lack of health care for this population. Rare previous studies address transgender women adherence to antiretroviral, with poor results and worrying results; In addition, rare scientific studies describe the quality of life in this population. This study focused on evaluating adherence to antiretroviral therapy, identified predictors for adherence, assessed quality of life, identified predictors for quality of life and explored the association between adherence and quality of life in a population of transgender women living with HIV/AIDS. We interviewed 106 transgender women treated at the outpatient clinic of the HIV / AIDS referral center in São Paulo about their adherence to antiretroviral, using a self-reported tool developed by Terry Beirn\'s group Community Programs for Clinical Research on AIDS and about quality of life using Patient Report Outcomes Quality of Life - HIV (PROQOL-HIV) questionnaire. We also used viral suppression as an indicator of adherence. Prior to the study, ethical clearance was obtained from a Health Research Ethics Committee and informed consent obtained from the study participants. Results formed part of adherence assessment. Data was analyzed using STATA 15.1, with x-square, Wilcoxon test, Spearman test and logistical regression analysis was performed. The sample declared 90% adherence to treatment in self-report, was created a new variable to measure adherence considering viral suppression and self-report, the results decrease to 78% of participants adherent; statistical analyses showed that younger transgender women have more chances to report low adherence. Most participants reported well to excellent quality of life, and lower schooling, depression, and illicit drug use were predictors for a worse quality of life score. We did not observe a statistically significant correlation between quality of life and adherence. Our study suggests good results from the service model adopted at the recruiting center. Multicentric studies with a larger number of participants and considering service units located in remote and less favored regions are necessary to express the real situation of adherence to antiretroviral and quality of life of transgender women.

Estimativas mundiais apontam que 19% das travestis e mulheres trans estão vivendo com HIV/Aids; no Brasil, a prevalência está acima de 30%. Essas taxas são crescentes e expressam a falta de atenção à saúde desta população. Raros estudos abordam a adesão dessa população aos antirretrovirais, com resultados preocupantes demonstrando falhas na adesão; além disso, escassos trabalhos científicos descrevem a qualidade de vida de travestis e mulheres trans vivendo com HIV/Aids. Este estudo teve por objetivos: (i) descrever a adesão à terapia antirretroviral de travestis e mulheres trans vivendo com HIV/Aids; (ii) identificar fatores associados com a adesão à terapia antirretroviral; (iii) mensurar a qualidade de vida entre travestis e mulheres trans vivendo com HIV/Aids; (iv) identificar fatores associados à qualidade de vida; e (v) explorar a associação entre qualidade de vida e adesão à terapia. A ferramenta para estimar a adesão foi o autorrelato desenvolvido pelo grupo Terry Beirn Community Programs for Clinical Reserch on Aids, além do parâmetro clínico carga viral. Para avaliação da qualidade de vida o questionário utilizado foi o Patient Report Outcomes Quality of Life - HIV (PROQOL-HIV). Este estudo foi aprovado pelo comitê de ética e pesquisa da Faculdade de Medicina da Universidade de São Paulo - FMUSP e pelo comitê de ética e pesquisa do Centro de Referência e Treinamento CRT Santa Cruz, além de estar em consonância com as diretrizes da resolução nº 510 de 2016 pelo Conselho Nacional em Saúde. Os dados foram analisados no programa STATA 15.1, sendo aplicados teste qui-quadrado, teste da soma dos postos de Wilcoxon, cálculo da correlação não paramétrica de Spearman e modelo de regressão logística multivariada. Cento e seis travestis e mulheres trans vivendo com HIV/Aids foram incluídas nesse estudo, das quais 90% declararam adesão ao tratamento; idade mais avançada foi identificada como fator associado a melhor adesão. O escore de qualidade de vida esteve entre boa a excelente em cinco dos 8 domínios do PROQOL-HIV; e menor escolaridade, depressão e uso de drogas ilícitas foram fatores associados com pior escore de qualidade de vida. Não observamos correlação estatisticamente significante entre qualidade de vida e adesão. Nosso estudo sugere que os resultados obtidos possam estar relacionados ao modelo de atendimento adotado no centro recrutador. Estudos multicêntricos, com maior número de participantes e que considere unidades de atendimento localizadas em regiões remotas e menos favorecidas são necessários para expressar a real situação da adesão aos antirretrovirais e qualidade de vida de travestis e mulheres trans. / Worldwide estimates indicate that 19% of transgender women are living with HIV / AIDS; in Brazil, the prevalence is above 30%. The increase of the numbers express the lack of health care for this population. Rare previous studies address transgender women adherence to antiretroviral, with poor results and worrying results; In addition, rare scientific studies describe the quality of life in this population. This study focused on evaluating adherence to antiretroviral therapy, identified predictors for adherence, assessed quality of life, identified predictors for quality of life and explored the association between adherence and quality of life in a population of transgender women living with HIV/AIDS. We interviewed 106 transgender women treated at the outpatient clinic of the HIV / AIDS referral center in São Paulo about their adherence to antiretroviral, using a self-reported tool developed by Terry Beirn\'s group Community Programs for Clinical Research on AIDS and about quality of life using Patient Report Outcomes Quality of Life - HIV (PROQOL-HIV) questionnaire. We also used viral suppression as an indicator of adherence. Prior to the study, ethical clearance was obtained from a Health Research Ethics Committee and informed consent obtained from the study participants. Results formed part of adherence assessment. Data was analyzed using STATA 15.1, with x-square, Wilcoxon test, Spearman test and logistical regression analysis was performed. The sample declared 90% adherence to treatment in self-report, was created a new variable to measure adherence considering viral suppression and self-report, the results decrease to 78% of participants adherent; statistical analyses showed that younger transgender women have more chances to report low adherence. Most participants reported well to excellent quality of life, and lower schooling, depression, and illicit drug use were predictors for a worse quality of life score. We did not observe a statistically significant correlation between quality of life and adherence. Our study suggests good results from the service model adopted at the recruiting center. Multicentric studies with a larger number of participants and considering service units located in remote and less favored regions are necessary to express the real situation of adherence to antiretroviral and quality of life of transgender women.