Faculty Bibliography

PURPOSE/OBJECTIVE:The objective of this study was to evaluate cross-sectional and longitudinal associations between contact with the criminal legal system (CCLS) and substance use among transgender women of color in New York City. METHODS:= 311). CCLS included arrest and incarceration and was measured at baseline, 6 months, and 12 months. Substance use included recreational substance use (any), alcohol use (any), and specific substance use (cannabis, cocaine, and methamphetamine). Generalized estimating equations were used to assess longitudinal associations between baseline CCLS and substance use over time. RESULTS:At baseline, 50.5% of participants reported having been arrested, and 28.0% reported experiencing incarceration. In multivariable analyses, CCLS was associated with substance use after controlling for confounders. In particular, at baseline, incarceration was associated with a 1.73 times (95% confidence interval: 1.06-2.81) likelihood of recreational substance use. We found no significant associations between CCLS and alcohol or specific substance use. CONCLUSION/CONCLUSIONS:The findings suggest that CCLS was associated with recreational substance use among transgender women of color at baseline. Substance use prevention and treatment programs should consider screening for substance use during reentry after incarceration and providing additional support for individuals with criminal legal system involvement.

PURPOSE/UNASSIGNED:This study aims to characterize demographic characteristics of transgender and nonbinary (trans) medical students and their training experiences. METHODS/UNASSIGNED:We conducted cross-sectional analyses of responses to the Association of American Medical Colleges Graduation Questionnaire (2016-2023) to characterize trans medical students using measures of race, ethnicity, age, and medical school region; assess overall satisfaction with medical training; and evaluate time to graduation, all compared to cisgender peers. RESULTS/UNASSIGNED:< 0.001). CONCLUSION/UNASSIGNED:With higher odds of being unsatisfied with their education, additional research must identify and develop interventions to improve their training experience.

Medical mistrust as a construct often places the onus of blame for adverse health outcomes on individuals rather than on social structures. In this study, we aimed to determine if medical mistreatment and access to transgender care were potential determinants of medical mistrust. We used longitudinal survey data from 193 transgender women of colour living in New York City. We measured medical mistrust using the Group-Based Medical Mistrust (GBMM) scale. Additionally, we analysed and coded open-ended survey data from participants regarding their trust towards medical institutions to identify potential determinants of medical mistrust. From the quantitative analysis, we found that individuals who experienced mistreatment in healthcare and those who reported poor access to transgender care had higher GBMM scores. Qualitative findings suggested that negative experiences within the healthcare system and historical trauma were key factors contributing to mistrust in medical institutions. Addressing medical mistrust should not occur at the individual level, but rather at the structural level. Potential interventions include improving access to gender affirming care and training health professionals.

BACKGROUND:There is emerging literature describing clinical characteristics and outcomes in patients with mpox treated with tecovirimat. METHODS:We analyzed retrospective deidentified data from healthcare systems in New York City with the highest number of tecovirimat prescriptions. Individuals with probable or confirmed mpox initiating tecovirimat from May-December 2022 were included. A chart abstraction instrument was used to extract demographic and clinical data from medical records. We examined factors associated with delay in treatment and hospitalization. RESULTS:A total of 708 individuals prescribed tecovirimat for mpox were included in the analysis; median age was 36 years (IQR 31-43); 566 (80%) were cisgender men who have sex with men; and 399 (56%) were living with HIV. Side effects (100, 14%) and severe adverse events (7, 1%) were rare. The most common long-term sequela was scarring (69, 10%). One hundred and one (14%) were hospitalized. Median time from symptom onset to treatment initiation was 8 days (IQR 6-11). Non-Hispanic Black patients had higher risk of initiating tecovirimat ≥8 days after symptom onset (relative risk [RR]=1.3, 95%CI: 1.2-1.7) and being hospitalized (adjusted relative risk [aRR]=2.2, 95%CI: 1.4-3.5) compared with Hispanic patients, after adjusting for HIV and insurance status. CONCLUSIONS:We described common reasons for tecovirimat initiation and hospitalization. There were racial inequities in hospitalization and treatment delays. More research and focused efforts to mitigate these inequities are needed. These findings may better inform decisions for treatment initiation and hospitalization for mpox.

BACKGROUND/UNASSIGNED:Transgender women of color in the US are disproportionately vulnerable to HIV risks. Pre-Exposure Prophylaxis (PrEP) has demonstrated effectiveness in preventing HIV transmission among transgender women of color. However, factors across multiple levels can hinder oral PrEP adherence. METHODS/UNASSIGNED:We analyzed the baseline data from The Trying to Understand Neighborhoods and Networks Among Transgender Women of Color (TURNNT) Cohort Study of women not living with HIV. We analyzed questionnaire responses to identify why participants stopped using PrEP and if they would consider taking it again. To identify multi-level determinants that were associated with PrEP discontinuation, we conducted bivariate analysis and created multivariable modified Poisson models comparing factors between former users and current users. RESULTS/UNASSIGNED:Among 140 transgender women of color included in this analysis, 44.3% were currently on PrEP, 25.0% were on formerly on the regimen, and 30.7% had never used it. Participants reported many reasons for discontinuing PrEP, notably, 22.9% reported being concerned about interactions with hormones. 60.0% reported that they were likely to take PrEP again in the future. Discontinuation was positively associated with history of sexual assault (Prevalence Ratio: 1.78; 95% CI: 1.01, 3.14) and negatively with having a primary care provider (PR: 0.43; 95% CI: 0.25, 0.73). CONCLUSION/UNASSIGNED:Many factors can influence PrEP discontinuation among transgender women of color. A majority of those who discontinued PrEP were interested in restarting it again, indicating a potential for reengagement. We recommend a holistic approach to HIV prevention to reduce PrEP discontinuation.

Transgender women of color (TWOC) are disproportionately impacted by psychological distress. Though gender-affirming care (GAC) has been recommended to alleviate this distress, research examining associations between perceived access to GAC, specific gender-affirming medical interventions (GAMIs), and mental health among TWOC in the United States remains limited. In this study, we examine cross-sectional and longitudinal associations between perceived access to GAC, completion of specific GAMIs, and psychological distress among TWOC, using modified Poisson regression and multilevel linear modeling. Data came from the Trying to Understand Relationships, Networks and Neighborhoods Among Transgender Women of Color (TURNNT) Cohort Study. In multivariable analyses, increased access to GAC was associated with reduced psychological distress risk. All assessed GAMIs suggested protective effects against psychological distress (aRR < 1), with statistical significance found for breast augmentation and facial feminization surgery. On average, those with unmet GAMI needs experienced higher distress risk than those without. Longitudinally, those experiencing reduced access to GAC over 6 months faced the highest distress risk among all trajectory groups (aRR: 1.40, 95% CI, 1.08-1.82). Our findings support the need for further inquiry in this area and suggest that policies protecting and increasing access to GAC may improve mental health among TWOC. This article is part of a Special Collection on Methods in Social Epidemiology.

PURPOSE/UNASSIGNED:This scoping review sought to synthesize human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, incidence, risk behaviors, and risk perceptions among transmasculine (TM) individuals globally. METHODS/UNASSIGNED:Eligible articles were peer-reviewed observational and interventional studies published in English between August 2, 2014 and November 2, 2021. Four electronic databases were systematically searched: PubMed, Embase, PsycInfo, and Sociological Abstracts and reference lists hand-searched. Results are presented using numerical summary and thematic analysis. RESULTS/UNASSIGNED:=39) spanned 12 countries and 2 multi-region studies. Laboratory-confirmed HIV prevalence ranged from 0% to 4% and self-reported HIV prevalence from 0% to 8%. Laboratory-confirmed STI diagnoses ranged from 1.2% to 7.7% for chlamydia, 0% to 10.5% for gonorrhea, 0% to 6% for syphilis, 1% to 8% for hepatitis C, and 0% to 8% for hepatitis B. Self-reported lifetime diagnosis of any STI ranged from 5.8% to 53.7%. No studies assessed HIV or STI incidence. Lifetime HIV testing prevalence varied from 23% to 89%. Lifetime STI testing prevalence ranged from 31.1% to 70.8%. Pre- and post-exposure prophylaxis use and knowledge were assessed in seven studies. Qualitative studies addressed HIV vulnerabilities and protective factors, including stigma and social, medical, and legal supports. CONCLUSION/UNASSIGNED:Although TM individuals are vulnerable to HIV and STI, incidence data are lacking. There is a dearth of research on the experiences, risk factors, and sexual behaviors of TM individuals, especially those who are nonbinary or ethnoracially minoritized. The collection of gender identity data in routine HIV surveillance is recommended. Services and interventions developed by and for TM individuals are needed.