Transgender and gender diverse (TGD) individuals experience high levels of stigma in a variety of settings and contexts, including during healthcare encounters. Persistent stigma and discrimination accumulating over a lifetime lead to hardships that increase health risks, such as engaging in harmful substance use and becoming infected with HIV. Yet, it is not yet clear if there is a relationship between stigma and engaging in HIV prevention clinical services among TGD individuals, and how substance use and HIV sexual risk behaviors might mediate this relationship. Further, little is known about the experiences and preferences of TGD patients when discussing substance use and HIV risk during primary care encounters and how providers address these health topics. Using a combination of elements from four distinct conceptual models which postulates components of syndemics, functions of communication, and clinical care delivery to TGD adult patients, this dissertation adds to the literature through three aims: Aim 1 uses structural equation modeling to test whether substance use, HIV sexual risk behaviors and gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (i.e., HIV prevention services or programs, pre-exposure prophylaxis use). This analysis includes a sample of 529 TGD adults in Massachusetts and Rhode Island who were HIV-negative or had an unknown HIV serostatus. Aim 2 uses semi-structured interview data with 25 TGD adults to explore experiences and communication preferences when discussing substance use and HIV risk during primary care encounters. Aim 3 uses in-depth interviews with 15 primary care providers to describe how they report discussions about substance use and HIV risk with TGD adult patients and characterizes how these communication approaches align with varying orientations of self-efficacy and subjective norms. Findings from this dissertation reveal several ways stigma manifests during clinical encounters and underscores the need for improving patient care experiences by alleviating provider knowledge deficits and fostering institutional support within clinic environments. / 2024-12-12T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45386 |
| Date | 12 December 2022 |
| Creators | Wolfe, Hill Landon |
| Contributors | Drainoni, Mari-Lynn |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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