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Fulltext Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students

O'Hara CA, Foon XL, Ng JC, Wong CS, Wang FY, Tan CY, et al.

Med Educ Online, 2023 Dec;28(1):2172744.
PMID: 36744296 DOI: 10.1080/10872981.2023.2172744

PURPOSE: International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education.
METHODS: This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression.
RESULTS: Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly.
CONCLUSION: Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

Matched MeSH terms: Transgender Persons*
Fulltext Correlates of viral suppression among HIV-infected men who have sex with men and transgender women in Lima, Peru

Rich KM, Valencia Huamaní J, Kiani SN, Cabello R, Elish P, Florez Arce J, et al.

AIDS Care, 2018 Nov;30(11):1341-1350.
PMID: 29843518 DOI: 10.1080/09540121.2018.1476657

In Peru, HIV is concentrated among men who have sex with men (MSM) and transgender women (TGW). Between June 2015 and August 2016, 591 HIV-positive MSM and TGW were recruited at five clinical care sites in Lima, Peru. We found that 82.4% of the participants had achieved viral suppression (VS; VL

Matched MeSH terms: Transgender Persons*
Correlates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia

Wang M, Lim SH, Gibson BA, Azwa I, Guadamuz TE, Altice FL, et al.

Int J STD AIDS, 2021 06;32(7):609-619.
PMID: 33752518 DOI: 10.1177/0956462420970417

Globally, cisgender women sex workers (CWSWs) and transgender women sex workers (TWSWs) experience increased vulnerabilities to HIV infection. Unfortunately, there is limited data on the drivers of HIV infection in these two understudied populations, particularly in Southeast Asia. To better understand factors associated with HIV infection, we evaluated correlates of newly diagnosed HIV infection in these two populations in Greater Kuala Lumpur, Malaysia. A total of 469 women (CWSW: n = 283; TWSW: n = 186) were included in this study. Most participants who tested HIV+ were unaware of their infection (59.6%; n = 34/57). Separate binary and multivariable logistic regressions were conducted to identify correlates of newly diagnosed HIV in CWSWs and TWSWs. Among CWSWs, Chlamydia trachomatis (aOR = 5.66; p = 0.007) and lifetime use of ecstasy/MDMA (aOR = 5.34; p = 0.03) were associated with newly diagnosed HIV, while condomless vaginal sex with clients was associated with lower likelihood of HIV infection (aOR = 0.98; p = 0.01). Among TWSWs, being single (aOR = 6.76; p = 0.03), using mobile application to solicit clients (aOR = 25.33; p = 0.006), and having C. trachomatis infection (aOR = 88.22, p = 0.02) were associated with newly diagnosed HIV. Expansion of HIV/sexually transmitted infection screening is needed to increase detection of HIV and linkage to care for sex workers. Interventions to reduce HIV infection among CWSWs and TWSWs should be tailored to these populations' unique vulnerabilities.

Matched MeSH terms: Transgender Persons*
HIV care continuum among cisgender and transgender women sex workers in Greater Kuala Lumpur, Malaysia

Ranjit YS, Gibson BA, Altice FL, Kamarulzaman A, Azwa I, Wickersham JA

AIDS Care, 2023 Jun;35(6):784-790.
PMID: 34723714 DOI: 10.1080/09540121.2021.1995839

An estimated 37,000 cisgender and transgender women work as sex workers in Malaysia, a population that has been disproportionately affected by the HIV epidemic. Although Malaysia provides no-cost antiretroviral therapy (ART) to people with HIV, little is known about sex workers' engagement in the HIV care continuum. We analyzed data from 57 HIV-infected cisgender women (n = 33) and transgender women (n = 24) sex workers from a respondent-driven sampling study on HIV prevalence among sex workers in Kuala Lumpur, Malaysia. We examined the proportion of women who were newly diagnosed with HIV, had a baseline CD-4 count test, were initiated and retained on antiretroviral treatment (ART). Overall, only 26.3% had ever been HIV tested and almost 60% were newly diagnosed. Only a small proportion of cisgender (15.2%) and transgender (12.5%) women were currently taking ART. Interventions to enhance sex workers' engagement in the HIV care continuum are urgently needed. Deployment of evidence-based strategies to improve linkage and retention in HIV care should be adapted to address the unique needs of this important key population.

Matched MeSH terms: Transgender Persons*
Combined genioplasty, chondrolaryngoplasty, and glottoplasty: A novel scarless procedure in facial feminization surgery

Labarthe P, Beaudoin PL, Wong E, Garrel R, de Boutray M, Damecourt A

J Stomatol Oral Maxillofac Surg, 2023 Dec;124(6S2):101575.
PMID: 37516199 DOI: 10.1016/j.jormas.2023.101575

Facial feminization is a long process with multiple surgical steps that is known to improve quality of life in transgender patients. Visible scars are a frequent complaint by this community as it adds to the stigmatization in this population. Combined procedures have been shown to be effective, by reducing the number of hospitalizations and the total length of recovery periods. In this context, we propose a novel scarless procedure combining a chondrolaryngoplasty, a glottoplasty, and a genioplasty using solely a transoral approach. First, we perform a glottoplasty according to the technique described by Wendler et al. and then a contraction genioplasty. Finally, the thyroid cartilage is approached by a subplatysmal dissection, between the mandibular osteotomy fragments. For now, 15 patients have benefited from this procedure in our department. Preliminary results demonstrate that this is an easy and safe procedure with good esthetic results and good patient satisfaction.

Matched MeSH terms: Transgender Persons*
Societal discrimination and mental health among transgender athletes: a systematic review and Meta-analysis

Chan ASW, Choong A, Phang KC, Leung LM, Tang PMK, Yan E

BMC Psychol, 2024 Jan 16;12(1):24.
PMID: 38229114 DOI: 10.1186/s40359-023-01493-9

BACKGROUND: Discrimination and inequality have been identified as significant problems faced by transgender individuals in sports participation. However, uncertainties remain regarding the effectiveness of interventions aimed at promoting equality.
OBJECTIVES: This systematic review and meta-analysis aimed to examine the experiences of transgender athletes in sports, focusing on mental health issues and factors contributing to inequality among transgender and other sexual minorities.
METHODS: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched 10 electronic databases, including PubMed, Google Scholar, and Web of Science, to identify eligible studies published between 2005 and 2022. The search yielded 1430 articles, of which only 12 studies met the inclusion criteria for this review.
RESULTS: The meta-analysis of the 12 studies included in this review revealed that transgender athletes faced social discrimination and inequality in sports participation, resulting in mental health problems and higher rates of suicide. From a cohort of 21,565 participants in the studies, 7152 (33%) were subjected to discrimination in sports participation and healthcare, with a rate of 0.61 (95% confidence interval [CI]: 0.35, 0.81). However, transgender athletes who felt welcomed and embraced by their respective teams accounted for 0.39 (95% CI: 0.19, 0.65). These results indicated significant differences between how transgender athletes are treated in healthcare settings and when participating in sports.
CONCLUSION: The study findings underscore the need for policies, cultural research, and interventions to address discrimination and inequality faced by transgender athletes in sports participation. Promoting equality and safeguarding the rights of transgender athletes can mitigate the risk of mental health problems and increase physical activity among sexual minorities.

Matched MeSH terms: Transgender Persons*
A Bibliometric Analysis of the Research on Social Attitudes Towards LGBT Community (2002-2022)

Yeo JY, Ting SH, Jerome C

J Homosex, 2024 Jun 06;71(7):1684-1702.
PMID: 36989378 DOI: 10.1080/00918369.2023.2186761

A bibliometric analysis was conducted to map out trends in publications on attitudes toward the LGBT community based on the 470 documents retrieved from the SCOPUS database for 2002-2022. The results revealed that the United States is the leading country contributing to the publications on attitudes toward the LGBT community and has a strong impact in the field (64.68%). The authorship analysis revealed that Flores, Woodford, and Worthen from the United States are the leading researchers in this field. Analysis of publication sources showed that the Journal of Homosexuality is the top publisher of findings on the LGBT community whereas the Journal of Interpersonal Violence and Sexuality and Culture have gained more traction among researchers in recent years. The analysis of the co-occurrence of author's keywords indicated that transgender is the gender group that is the most researched compared to other sexual identities. Negative attitudes such as homophobia, discrimination and being heterosexist toward one's sexuality or same-sex marriage are the current research foci. Religion and culture are seen as important predictors of attitudes about homosexuality and same-sex marriage policy. The study addresses the gaps in the literature by recommending future researchers to investigate attitudes toward other gender identities as a result of the revolution in sexual identities.

Matched MeSH terms: Transgender Persons*
Transgender health in India and Pakistan

Ming LC, Hadi MA, Khan TM

Lancet, 2016 11 26;388(10060):2601-2602.
PMID: 27894657 DOI: 10.1016/S0140-6736(16)32222-X
Matched MeSH terms: Transgender Persons*