Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru. / National Institutes of Health / Revisión por pares

Bakgrund: Transpersoner är en del av samlingsnamnet HBTQI och inkluderar alla personer som anser att deras könsidentitet inte stämmer med deras kön vid födseln. Stigma och juridiska hinder präglar transpersoners värld vilket kan vara några anledningar till att transpersoner inte vill söka vård. Syfte: Syftet är att beskriva transpersoners erfarenheter av fysiska vårdmöten med sjuksköterskor inom primär- och slutenvården. Metod: En litteraturöversikt som utgått från tolv artiklar med kvalitativ design med fokus på transpersonernas perspektiv. Artiklarna publicerades mellan 2016–2022 och samlades in från Cinahl, Medline och PsycINFO. Analysen gjordes med Fribergs analysmodell. Resultat: Resultatet resulterade i tre huvudteman; diskriminering, sjuksköterskans kompetens och bristen på samskapande vård. Identifieringen av sex subteman gjordes; integritet och respekt, att bli felaktigt könsidentifierad, bristande kunskap hos sjuksköterskor, att utbilda sjuksköterskor, beroendeställning till sjuksköterskor och könsspecifik vård. Slutsats: Arbetet indikerar att en förändring kring bemötande med transpersoner måste ske för att öka tilliten till vården. En ökad tillit till vården kan leda till en ökad vilja att söka vård vid behov. Förslag till vidare forskning är en intervjustudie som kartlägger utbildningsbehovet kring könsspecifik vård. / Background: Transgender people are part of the collective name LGBTQI and include all people who feel that their gender identity does not match their gender at birth. The existence of the refusal to seek care due to various reasons, such as stigma and legal obstacles, characterizes the world of transgender people. Aim: The aim is to describe transgender people's experiences of physical care meetings with nurses in primary- and inpatient care. Method: A literature review based on twelve articles with qualitative design focusing on trans people's perspective. The articles were published between 2016–2022 and were collected from Cinahl, Medline and PsycINFO. The analysis was done with Friberg's analysis model. Result: The result showed three main themes; discrimination, the nurse´s competence, and the lack of co-creative care. The identification of six subthemes was done; integrity and respect, to be incorrectly gender-identified, lack of knowledge among nurses, to train nurses, dependence on nurses and gender-specific care. Conclusion: The literature review indicates that a change in treatment of transgender people must take place to increase trust in healthcare. Increased trust in care can lead to an increased willingness to seek care when needed. Proposals for further research are an interview study that maps the educational need for gender-specific care.

Transpersoner är en grupp som i forskning observerats löpa särskild risk för social utsatthet. Transpersoners levnadsvillkor i relation till den egna könsidentiteten i fråga om sådant som juridisk könstillhörighet och könskorrigerande är något som regleras i lag. Denna uppsats syftar till att undersöka hur transpersoners attribut och den statliga regleringen av transpersoners kroppar och könsidentitet framställs i statens offentliga utredningar under 1960- och 2010-talet. En tematisk analys av en utredning från respektive tidpunkt har genomförts, och materialet har analyserats med utgångspunkt i Judith Butlers teorier om den heterosexuella matrisen och gender performance theory samt Natacha Kennedys framställning av begreppet cisgenderism. Vi fann att framställningen av transpersoners attribut såväl som regleringen av transpersoners könsidentitet i lag till vissa delar skiljer sig mellan utredningarna, men att vissa aspekter kvarstår. Framställningen av transpersoners psykiska varande har förändrats från en psykiskt sjuk avvikare som behöver diagnostiseras som sådan och behöver anpassas såväl beteendemässigt som fysiskt till rådande könsnormer, till en delvis mer tillåtande syn på transpersoners könsidentitet där den juridiska könstillhörigheten menas kunna tillåtas vara upp till transpersonen själv att besluta om. Dock kvarstår diagnosförfarandet även under 2010-talet i fråga om könsdysforidiagnosen som villkorar transpersoners rätt till könskorrigerande vård av kroppen, något som visar på att aspekten av medikalisering av transpersoners varande såväl som den statliga kontrollen över könsidentiteten har kvarstått över tid. Med utgångspunkt i våra valda teorier har vi även noterat att beskrivningen av könsnormernas samhälleliga roll har förändrats över tid från något samhällsavgörande till något som till viss del betraktas som föränderligt, och att förändringen i framställningen av dessa normers innebörd även tycks inverka på hur transpersoner framställs.

This study qualitatively examined the experiences of transgender individuals who also identify as active members of the Church of Jesus Christ of Latter-day Saints (N=10). Researchers took an interpretive phenomenological approach to elicit factors which allow trans Mormon folks to hold their apparently conflicting religious and gender identities simultaneously (and the consequences of doing so). Overall, we aimed to answer the broad question, “what is it like to be transgender and Mormon?” Following a process of semi-structured interviews, transcription, and coding, the broad categories which seemed to connect many elements of the trans/Mormon experience were 1) a sense of being pulled in two directions, 2) experiences of sacrifice, and 3) experiences of loss and rejection. Findings suggest that sacrifices of authenticity, gender expression, and well-being were made because of a desire to: a) be accepted within the LDS Church, b) promote change within the LDS Church, c) maintain family relationships, d) live congruently with one’s personal interpretation of doctrine, and/or e) follow personal guidance from God. Results also suggest that most experiences of loss and rejection for trans Mormons center around their church communities and local leadership, the LDS Church as an institution, and LDS family members.

The thesis deals with the normative discourse of transsexuality, both from a general cultural- historical perspective in the context of Western science and medicine and more specifically in the context of Czech sexology. On a detailed analysis of the publication Transsexualita: Diagnostika a léčba (Transsexuality: Diagnostics and Treatment), I illustrate the currently dominant conceptualization of transgender and/or transsexuality as a disorder, which, due to its normative influence, predetermines not only the possibilities of (self)identification available to trans* people in the Czech Republic, but also their treatment by Czech society and state institutions (e.g. in the conditions to be met for legal gender recognition, which still include compulsory sterilization). Methodologically, the thesis is chiefly grounded in discourse analysis, but it also shows an ethical standpoint in relation to the situation of Czech trans* people in the legal and medical systems. I also consider the factual dimension of transgender status and other expressions of gender diversity, primarily in maintaining a critical distance from the notions of their alleged pathology, still widespread in the normative sexological discourse. Keywords Biology, discourse, ethics, human rights, intersex, normativity, pathologization,...

Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.

Bakgrund: Transpersoner har betraktats som en marginaliserad och utsatt grupp i samhället. Det har framkommit exempel på diskriminering och stigmatisering från samhällsstrukturer och normer. Både från omgivningen och internaliserat. Vidare har det visat sig leda till att transpersoner löper ökad risk för psykisk ohälsa och missbruk utöver deras transspecifika omvårdnadsbehov. Syfte: Litteraturstudien beskrev transpersoners erfarenheter av bemötandet i hälso- och sjukvården. Metod: Studien var en beskrivande litteraturstudie. Huvudresultat: De mest framträdande fynden i resultatet innefattade kommunikationen mellan vårdgivare och transpersoner. Negativa upplevelser av vårdmöten karaktäriserades av när transpersonerna blev bemötta respektlöst utifrån affirmerat pronomen och identitet. Negativa upplevelser präglades även av vårdpersonalens egna värderingar, där transfobi beskrevs, eller en skillnad i kunskap mellan vårdgivare och transpersonen gällande transhälsa. Resultatet av respektlösheten kunde i sin tur leda till att vården fick minskad kvalité eller uteblev. Goda upplevelser i möten präglades av respekt för individen, kunskap om transhälsa samt acceptans och förståelse. Slutsats: Hur transpersoner bemötts inom hälso- och sjukvården har präglats av positiva och negativa erfarenheter. Att vårdpersonalen haft transhälsorelevanta kunskaper och förmåga att möta transpersonen med ett holistiskt och personcentrerat förhållningssätt har potential att kunna bidra till att öka hälsa och förebygga ohälsa. / Background: Transgender people have been seen as a marginalized and vulnerable group in society. Examples of discrimination and stigmatization have emerged from societal structures and norms. Both from the environment and internalized. Furthermore, it has been shown that transgender people are at increased risk of mental illness and substance abuse in addition to their trans-specific nursing needs. Aim: The literature study described transgender persons experiences of professional-patient relations in health care. Method: The study was a descriptive literature review. Main results: The most prominent findings included communication between caregivers and transgender people. Negative experiences of care meetings were characterized by when the transgender people were treated disrespectfully by not referring to their affirmed pronoun and identity. Negative experiences were also characterized by the care staff's own values, where transphobia was described, as well as a difference in knowledge between caregivers and the transperson regarding transhealth. The result of this disrespect could in turn lead to quality of care being reduced or care being not available. Good experiences in meetings were characterized by respect for the individual, knowledge of transhealth as well as acceptance and understanding. Conclusion: How transgender people have been treated in health care has been characterized by positive and negative experiences. The fact that healthcare staff have had transhealth-relevant knowledge and the ability to meet the transgender person with a holistic and person-centered approach has the potential to contribute to increasing health and preventing ill health.

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p <.01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79–8.04), partner concurrency (4.42, 1.19–16.40), and participant alcohol (4.71, 1.82–12.17) or drug use (5.38, 2.22–13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01–7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use. / Revisión por pares

For over two decades, the inclusion of trans women in women’s spaces and organizations such as transition houses has been discussed and debated by women-only organizations, feminists, trans activists, and the broader public. Drawing on an interpretive description approach, my research examines the experiences of transition house counsellors (“counsellors”) who have worked with trans women accessing residential support. My research topic and questions emerged from my experience as a counsellor and are informed by a desire to better meet the needs of trans women affected by intimate partner violence (“IPV”), and to help fill gaps in available research, information, and practical resources to help service providers meet the needs of trans women affected by IPV. Specifically, my research questions are: (1) what challenges, opportunities, and insights do counsellors experience when working with trans women clients, and (2) how do counsellors adjust and adapt their practices in response to these challenges, opportunities, and insights when working with trans women accessing transition house support? Using purposive sampling, I recruited nine counsellors who have worked with trans women accessing transition house support. Data collection involved semi-structured in-depth-interviews of these participants to gain an understanding of their experiences and perspectives related to working with trans women accessing transition house support. Consistent with an interpretive description approach to research, I analyzed my data by drawing on both my experience as a counsellor and through thematic qualitative analysis. My research finds that participants unanimously supported the inclusion of trans women in transition house settings. While the majority of participants emphatically stated that they did not respond to trans women any differently than they did to cis women, my findings show that how participants responded to trans women was informed by how well they perceived a trans client’s gender expression to match her gender identity. As such, my analysis reveals that participants’ responses to trans women was mediated by their unconscious adoption of a broader dominant heteronormative cisgenderist IPV framework that operates at both an individual and institutional level. My research therefore highlights some of the limitations that affect trans women accessing transition house support when counsellors and organizations respond to IPV through a heteronormative cisgenderist framework. / Graduate

Gender diverse individuals experience stigma, discrimination, and transprejudice regularly, in response to daily interactions with society. These negative experiences lead to the development of physical, mental, and emotional instability. Gender diverse individuals experience transprejudice and discriminatory experiences in transpohobic counseling environments. Furthermore, current research highlights the need for counselors to increase training and knowledge to work with gender diverse individuals. The purpose of this hermeneutic phenomenological study, grounded in a Heideggerian philosophy, was to illuminate the lived experiences of professional counselors engaging in counseling with gender diverse clients and bridge the gap in the current literature. Data were collected from 7 licensed professional counselors with experience counseling gender diverse clients. using a semistructured interview and followed a structured thematic analysis process incorporating components of interpretive phenomenological analysis, ensuring thematic saturation. The results of this study highlighted 10 major themes and seven subthemes inclusive, but not limited to education and training, understanding gender diversity issues, intentional bias, and professional experience. These study findings provide insight regarding the potential to improve counselor training and preparation. Ultimately increasing knowledge and education may impact and improve the lives for the gender diverse clients by reducing transprejudice, transphobia, and other forms of bias.