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Titel: Man, woman, both or neither – a study of social workers´ knowledge of and attitudes towards transgender peopleThe purpose of this essay was to study whether there is a connection between social workers' knowledge of and attitudes towards transgender people and if the attitudes differ depending on, if the social workers have experiences of meeting a transgender person in their profession, or not. The study was cross-sectional based on a web questionnaire that was answered by 57 social workers in Social Services providing economic support. Therespondents consisted of a convenience sample, and a request to participate in the study was sent to 38 municipalities all around Sweden, of which 17 municipalities are represented in the study. The results show that the correlation between knowledge and attitudes are low and that the differences in attitudes, depending on whether the social workers has met a transgender person or not, are not statistically significant. An explanation for these results may be a low response rate and the results cannot be generalized to the entire population of social workers in departments for economic support. Further research on the subject is needed as this study can be seen as a pilot study. / Titel: Man, kvinna, både-och eller ingetdera – en studie om socialsekreterares kunskaper om och attityder till transpersonerSyftet med detta arbete är att studera om det finns ett samband mellan socialsekreterares kunskaper om och attityder till transpersoner samt om attityderna skiljer sig beroende på om socialsekreterarna har mött en transperson i arbetet eller inte. Studien är genomförd med en kvantitativ tvärsnittsstudie i form av en webbaserad enkät som besvarades av 57 socialarbetare inom ekonomiskt bistånd. Valet av respondenter gjordes med hjälp av ett bekvämlighetsurval och en förfrågan om att delta i studien skickades till 38 kommuner runt om i Sverige, varav 17 kommuner finns representerade i studien. Resultatet visar att sambandet mellan kunskaper och attityder är lågt samt att skillnaderna i attityder, beroende på om socialsekreteraren har mött en transperson eller inte är statistiskt signifikanta. Detta kan bero på att uppsatsen har låg svarsfrekvens och inte kan generaliseras på hela populationen. Vidare forskning på ämnet behövs då denna studie kan ses som en förstudie.

In 2011 the National Academy of Medicine identified research gaps related to transgender populations and suggested a research agenda that included, among other goals, investigating health outcomes related to transition related care. The overarching goal of this dissertation therefore is to add to the body of knowledge about the state of health of transgender individuals, including utilization of gender-affirming care, preventive care and screening practices for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This dissertation includes three manuscripts. The first is a retrospective chart review including 1670 transgender patients, aged 18 and up (mean age 35.57 years), at a community health center to examine utilization of gender-affirming procedures as well as investigate the prevalence of smoking and uptake of colon cancer screening compared to New York City benchmarks using data from the New York City Community Health Survey (NYC CHS). The results revealed transgender individuals had high uptake of gender affirming hormones (81.9%) but fewer had undergone gender-affirming surgeries (31.5%). Transgender individuals had almost double the rate of current cigarette smoking compared to adults aged 18 and up in the New York City Community Health Survey (OR=1.92, 95% CI=1.61, 2.28) and also had suboptimal colon cancer screening rates compared to New Yorkers aged 50 and older (OR=0.16, 95% CI=0.11, 0.23). The second paper is a scoping review of the literature to investigate postoperative outcomes related to vaginoplasty procedures in transgender women. One hundred and three articles met inclusion criteria and provided information on immediate as well as long term health outcomes. The review demonstrated many inconsistencies in the timing of follow-up as well as how outcomes were measured, but provided invaluable information on the many types of postoperative issues that may be seen after vaginoplasty surgery. Lastly, the third paper examined the prevalence of HIV and STI testing behavior and prevalence of HIV infection among transgender people in a community health center setting. This analysis demonstrated that HIV screening rates were lower than expected (55.7%) given the elevated HIV prevalence in the population. In the multivariate analysis the odds of HIV screening among transmasculine individuals was higher in those who had undergone gender affirming surgeries (OR=1.67, 95% CI= 1.08, 2.58), had a substance use history (OR=5.18, 95% CI=1.41, 18.99) and a history of genital warts (OR=4.64, 95%CI=1.24, 17.34). Among transfeminine individuals the odds of HIV screening were higher in those with only cisgender male partners (OR=2.18, 95% CI=1.52, 3.11), gender affirming surgery (OR=2.56, 95% CI=1.53, 4.31), substance use history (OR=2.76, 95% CI=1.23, 5.78) and genital warts (OR=2.69, 95% CI=1.20, 6.02). HIV prevalence was higher among transfeminine compared to transmasculine individuals (28.1% vs. 2.8%, p<.001). In the multivariable analysis having only cisgender male sex partners increased the odds of HIV infection among transmasculine individuals (OR=10.58, 95% CI=1.33, 84.17), while having at least a high school diploma reduced the odds of infection (OR=0.08, 95% CI=0.01, 0.72). Among transfeminine individuals increased odds of HIV-infection were seen in those who were unemployed (OR=1.7, 95% CI=1.1, 2.64) and those who had a history of genital warts (OR=2.54, 95% CI=1.37, 4.70). White individuals had a lower likelihood of HIV infection (OR=0.40, 95%CI=0.21, 0.73). Overall these three studies provide important information about transition-related, primary and preventive healthcare for transgender populations. The findings of elevated cigarette smoking, underutilization of colorectal cancer screening and low HIV and STI screening rates occurred in this study despite the fact that transgender people were engaged in medical care. Clinics and other health settings that provide transgender health services should include robust metrics for monitoring uptake of preventive health care services and work to improve uptake of services when disparities are evident.

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

Antalet diagnoser av könsdysfori (KD), har ökat markant i Sverige och andra delar av västvärlden sedan 2008. Merparten av denna ökning utgörs av flickor i tonåren, vilka numera utgör den största gruppen av transpersoner. Tidigare studier av denna till synes nya population baseras på rapporter från föräldrar, som kan vara icke-representativa på flera olika sätt. För att undvika en del av dessa problem rekryterades skolpersonal, som fick besvara en enkät om antalet transidentifieradeelever som de känner till, och hur många som förekommer i samma klass eller kamratgrupp. Hypoteserna var att (1) transpersoner i åldrarna 13- 20 år är födda som flickor i högre utsträckning än som pojkar, (2) att fler än en transidentifierad elev återfinns i samma klassrum eller sociala krets inom en skola är vanligare än förväntat av slumpen, och (3) detta är vanligare bland flickor än pojkar. Enkäten annonserades via Facebooksidor och via e-post till rektorer för svenska grund- och gymnasieskolor. Den besvarades av 196 personer, som rapporterade om 176 transpersoner i 103 olika skolor. Av dessa var 103 flickor (58.5%) och 73 pojkar (41.5%), vilket är en signifikant skillnad. 12 transpersoner var samtidiga i samma klass, 24 i samma kamratgrupp, och 72 i samma skola. Som mest gick fyra transpersoner i samma skola under samma tid. I inget klassrum eller kamratgrupp rapporterades fler än två transpersoner. Utifrån dessa antal kunde inga definitiva slutsatser dras men vårt sampel indikerade att KD inte är medierad inomkamratgrupper. / A significant increase of gender dysphoria (GD) diagnosis has been reported in Sweden and the rest of the West since 2008. The majority of the increase is attributed to biological girls, 13-20 years, who have superseded biological boys in the amount of GD diagnosis. Studies of this seemingly new population were based on parentreports, which can be considered as non-representative for various reasons. To avoid some of those issues school-personnel were recruited as respondents. Three hypotheses were tested; (1) transpersons 13-20 are born as girls at a higher rate than boys, (2) more than one transidentified student in a classroom or social circle in a school is more common than expected by chance, (3) if 2 differs between the sexes it ́s more common amongst those born as girls than those born as boys. The survey posed questions regarding the quantity of transpersons respondents encountered, how many of those were in the same classroom. It was posted on Facebook- pages and emailed to principals of Swedish elementary- and upper secondary schools. 196 persons responded and reported 176 transpersons in 103 different schools. Girls were overrepresented, 103 (58.5%) versus 73 boys (41.5%). Of the 176 reported transpersons, 72 attended a schoolwith at least one other transperson. 12 were part of the same classroom, 24 of the same friendgroup. No more than 4 attended the same school. No class or friendgroup consisted of more than two. No definitive conclusions were made but our sample indicated that GD was not mediated by friendshipgroups.

The ​aim​ of this study was to examine transgendered persons experiences of social norms andattitudes related to their gender identity. More specifically the study focused on thecisgender- and hetero norm and how these affect transgender persons transition process andtheir everyday life. The ​method​ used to collect data was by reading five autobiographicalbooks written by transgendered persons. Collected data was analyzed using queer theory andthematized into four different themes; ​The importance of passing, The environments attitudesand reactions, To be yourself or someone else ​and ​Social relationships​. The​ results ​indicatethat transgendered persons are highly affected by norms and are often victims ofdiscrimination due to their gender identity. To “pass” as either man or woman is thereforecrucial to avoid negative attitudes and harassment. The results also showed the difficulty fortransgendered persons to reveal their gender identity to society and their close ones and howdifferent reactions can either discourage or normalize the heteronormative structures thatexists in our society. The​ conclusion ​was that transgendered persons are affected bycisgendered- and heteronormative norms in both their transition process and their everydaylife. Society is categorizing people as either man or woman, and whoever doesn’t fit in thegiven gender roles is classed as deviant

The focus of this research was to describe gender role experiences and gender transformation from a systems psychodynamic stance. Women have fought to overcome past oppressions but society intended to label women continually as traditional homemakers. In organisations, women are still subjected to receiving certain non-challenging jobs, such as administrative tasks, secretarial and office assistant duties as compared to men who fulfil professional and managerial roles. Men, on the other hand, experience the daily pressures of living up to societal brandings, which regard them as tough bosses and breadwinners. Hermeneutic phenomenology enabled participants to share their lived gender role experiences. Furthermore, the hermeneutic paradigm assisted the researcher with an in-depth understanding of participants’ phenomenological experiences. The researcher therefore explored, analysed and described the phenomenological gender experiences of male and female employees and a transgender employee from a systems psychodynamic stance. Semi-structured interviews were conducted with four male and four female participants. Men and women often projected positive behaviours onto each other that would result in them challenging and breaking the obsolete, stereotypical thinking handed out by society. The isolation and loneliness experienced by transgender persons manifest in unauthentic and false living. The organisation created high levels of anxiety in its employees’ which contributed towards male, female and transgender role experiences. Individual defence mechanisms were used as a method of addressing anxieties. Men, women and v transgender persons were affected by their constant need for recognition and advancement in the organisation but refused to show any concerns for fear of consequences from the leaders of the organisation. Men, women and transgender persons became containers and shared the emotional burdens of the organisation and their family life in different ways. Recommendations for gender transformative approaches are discussed to address issues of inequality in the organisation. / M. Com. (Industrial and Organisational Psychology)

This dissertation explores multidimensional social support across the perinatal period among sexual and gender-diverse (SGD) childbearing individuals living in the United States. The Social-Ecological Model (SEM) of Health Promotion and resilience theory guided this dissertation. Chapter One provides an overview of emerging health disparities among SGD childbearing people and compelling evidence of their risk for mental health disparities. It also identifies our limited understanding of perinatal social support among this population — an important modifiable risk factor for adverse mental health. Thus, social support was identified as a promising topic for this dissertation that could promote perinatal health and well-being among an understudied childbearing population. Chapter Two, Childbearing at the Margins: A Systematic Metasynthesis Review of Sexual and Gender Diverse Childbearing Experiences, evaluated and synthesized data from 25 studies on SGD childbearing. Three main themes were identified (1) Systematic Invisibility: Erasure, Structural Exclusion, Discrimination; (2) Creating Personhood Through Parenthood; and (3) Resilient Narratives of Childbearing. We found widespread structural and interpersonal harm and discrimination across the childbearing period while also emerging evidence of positive social experiences and resilience. Gaps in the literature were identified, including data on racially and geographically diverse SGD childbearing populations, perinatal support experiences beyond the healthcare context, and data derived from prospective studies. Chapter Three, “Through Our Resiliency We…Find Joy”: A Community-Placed Qualitative Study of Social Support Among Sexual And Gender Diverse Childbearing People, introduces The Study of Queer and Trans Perinatal Resilience and Experiences of Gestation (PREG). This chapter sought to understand perinatal risk and resilience among SGD childbearing individuals at the inter-and intrapersonal levels of the SEM — namely, coping skills and social support. Four main themes were identified: 1) Entering a New Season of Life, 2) Community is Family, 3) The Pain We Bear, and 4) Obligatory Resilience. We found that this new season of life came with unique support needs and sources of support. Support systems were robust and generally diffuse. Family formation signaled a time to heal old wounds among families of origin while simultaneously a time of increased harmful experiences and sacrifices to maintain access to support. Due to a history of stigma and discrimination, SGD individuals had well-developed coping strategies that mitigated harm. They found building a family a profoundly meaningful experience that provided great joy and purpose. Chapter Four, “You’re Preparing for People to Assess Whether You Can Have Your Own Child”: Structural Failures to Support Sexual and Gender Diverse Childbearing Parents, explores social support and social needs at the community, organizational, and policy levels of the SEM to understand how structural factors support or fail to support SGD childbearing people. Three main themes were identified: 1) When Protections Fail to Protect, 2) The Burden Is on Our Shoulders, and 3) When Privilege Is Protection. We found that despite advances in legal protection of SGD people, numerous factors undermine the ability to access protections across the childbearing journey. Thus, SGD individuals are faced with impossible choices when building their families and are forced to advocate for themselves, educate others, and pay to access structural support. Class and racial privilege may play a role in protecting SGD people from these burdens. Chapter Five summarizes the findings from the three manuscripts in this dissertation, highlighting the strength and weaknesses of the studies, and research, clinical practice, and policy implications. Taken together, the heterocisnormative framework of family formation creates structural stigma and contributes to interpersonal conflict and exclusion that may increase vulnerability to perinatal mental health disparities among SGD childbearing individuals. However, SGD individuals also demonstrated resilience by using well-developed coping strategies and robust social support networks, achieving what was for many a lifelong dream of having a family. This dissertation provides an important contribution to the scientific literature by describing and characterizing perinatal resilience and stigma at each level of the SEM and, in doing so, provides a roadmap to inform clinical practice, policy, and future research in pursuit of promoting perinatal health equity among a marginalized childbearing population.

This thesis focuses on gender-based discrimination in the application of French legislation. Discrimination is a major principle of Human Rights. Women and gender minorities, although they are subjected to discrimination, are protected by international treaties and conventions against it. With a Qualitative Content Analysis, this thesis will study different court cases in order to see, through the lens of the Feminist Jurisprudence Theory, the situation of gender-based discrimination in the application of French legislation. The conclusion of this thesis is that, while there is gender-based discrimination in the application of legislation, it comes mostly from how the experience of the individuals is considered by the courts. The higher and lower courts have also different outcomes in some of the cases, due to the role and focus they have. The main discrimination that can be found is indirect discrimination.