Faculty Bibliography

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.

OBJECTIVE:Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure. DESIGN/METHODS:We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life. SETTING/METHODS:This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center. PARTICIPANTS/METHODS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains. RESULTS:The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection. CONCLUSIONS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients' lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

BACKGROUND:Hepatitis C virus (HCV) reinfection rates are substantially higher than primary infection rates among men who have sex with men (MSM) with human immunodeficiency virus (HIV) in European cohorts. The behaviors mediating this high rate of transmission among MSM are poorly characterized. METHODS:We performed a prospective cohort study in New York City (NYC) of MSM with HIV who cleared HCV to determine the incidence of and risk factors for HCV reinfection. We assessed the risk behaviors for primary HCV in NYC: receipt of semen in the rectum, and sexualized methamphetamine use, along with route of use. Multivariable analysis was performed with Andersen-Gill extension of the Cox proportional hazards model. RESULTS:From 2000 through 2018, among 304 MSM with HIV who cleared HCV, 42 reinfections occurred over 898 person-years, for an incidence rate of 4.7 per 100 person-years. Assessing 1245 postclearance visits, only receipt of semen into the rectum was associated with reinfection (hazard ratio, 9.7 [95% confidence interval: 3.3-28.3], P < .001); methamphetamine use was not. CONCLUSIONS:The high HCV reinfection rate over almost 2 decades demonstrates that sexual transmission of HCV is not inefficient or unusual and that direct-acting antiviral treatment is not sufficient for HCV elimination among MSM in NYC. The contrasts between both the rates of and risk factors for primary and HCV reinfection suggest that HCV prevalence is highly heterogenous among sexual networks and that sexualized methamphetamine use, rather than mediating transmission, is instead a surrogate marker for the highest HCV prevalence networks. As neither condoms nor treatment have been successful strategies for HCV prevention in NYC, novel interventions are needed to stem this sexually transmitted HCV epidemic.

OBJECTIVES/OBJECTIVE:We used community-based mixed methods to test whether transgender and gender diverse (TGD) people preferred gender identity questions developed by community members over current questions in use and generate hypotheses about data collection preferences. METHODS:We interviewed twenty TGD adults in English and Spanish, asking them to rate and discuss their responses to questions. We analyzed quantitative data with descriptive statistics and qualitative data with template analysis, then integrated them. RESULTS:More participants preferred gender identity questions that were currently in use. Themes: 1) TGD participants find questions about "gender" and related terminology unclear because of conflations of sex, gender, and other constructs. 2) TGD participants resist cisgenderism in questions about gender identity. 3) TGD people desire questions that allow for autonomy, privacy, and safety. 4) Contextual factors, particularly safety, influence whether and how TGD people answer questions about gender and sex. CONCLUSIONS:TGD people have varied concepts of sex and gender and preferences about data collection. Future research should investigate the impacts of disentangling gender, sex, and biological factors, which could decrease stigma for TGD people. PRACTICE IMPLICATIONS/CONCLUSIONS:Medical care that disentangles gender, sex, and biological factors could improve data collection effectiveness and the safety of TGD people.

Ever since the Cass Review was released in April-an evaluation by the United Kingdom's National Health Service that has led to a ban on pubertysuppressing medication for transgender and gender diverse (TGD) youth-there has been criticism of the assessment and its recommendations, and concern about how it could be leveraged to more broadly affect public health care. In response, physicians, researchers, and major medical organizations worldwide have emphasized that scientific studies point to the benefits of medical interventions supporting gender affirmation. Indeed, more care innovation is needed, driven by community-led research, to improve the well-being of TGD people in ways that can benefit all of society.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

In the United States, it is estimated that 0.3% of Americans aged 65 and older, or almost 172,000 individuals, identify as transgender. Aging comes with a unique set of challenges and experiences for this population, including health care disparities, mental health concerns, and social isolation. It is crucial for clinicians to use a patient-centered and trauma-informed care approach to address their specific needs and provide evidence-based quality health care, including preventive screenings, mental health support, and advocating for legal protections.

OBJECTIVE:To evaluate the incidence of gender-affirming phalloplasty and complications in a large population-based dataset. METHODS:Retrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS:We identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1 year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. CONCLUSIONS:This population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision making, and institutional and government policy.