Global health burden and needs of transgender populations: a review

Transgender people are a diverse population aff ected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance eff orts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are suffi cient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affi rmation as a public health framework, improved health systems and access to health care informed by high quality data, and eff ective partnerships with local transgender communities to ensure responsiveness of and cultural specifi city in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.

Transgender health 3 Global health burden and needs of transgender populations: a review

INTRODUCTION: In the past five years, researchers have increasingly turned to the study of mental health outcomes in LGBt populations. the present paper summarizes recent literature on the relationship between minority stress experienced by sexual minorities and mental health. eViDeNce acQUisitiON: PsyciNFO, PubMed, and the eBscO Psychology and Behavioral science collection were searched for papers concerning minority stress and mental health disparities in LGBt populations, published between 1 January 2014 and 30 June 2018. all collected papers were screened using the following criteria: study involving >50 individuals; written in english; focusing on clinical outcomes of depression, suicidality, and substance use in relation to experienced minority stress. eViDeNce sYNthesis: sixty-two papers were included in this review. Findings are reported under three main headings: studies primarily focused on depression, studies concerning suicidality and suicide attempts, and papers analyzing the correlation between substance use and minority stress in LGBt populations. the included studies supported the minority stress model as a framework to better explain disparities in mental health outcomes in sexual minority populations. higher rates of depression, suicidality, and substance use are reported in LGBt populations, as are the related minority stressors analyzed. cONcLUsiONs: sexual minorities still face numerous mental health disparities. research indicates that the levels of minority stressors positively predict mental health outcomes. Specific policies designed to support the civil rights of sexual minorities may help to overcome such inequalities. (Cite this article as: Mongelli F, Perrone D, Balducci J, sacchetti a, Ferrari s, Mattei G, et al. Minority stress and mental health among LGBt populations: an update on the evidence. Minerva Psichiatr 2019;60:27-50. DOi: 10.23736/s03911772.18.01995-7)

/pdf/minority-stress-and-mental-health-among-lgbt-populations-an-cxeoqllhdu.pdf

Minority stress and mental health among LGBT populations: an update on the evidence

Social isolation describes a lack of a sense of belonging, the inability to engage and connect with others, and the neglect or deterioration of social relationships. This conceptual review describes how social isolation and connectedness affect the well-being of LGBTQ youth. Most studies focused on the psychosocial experience of social isolation, which led to suicide attempt, self-harm, sexual risk, and substance use. Scholarly work has drawn from a variety of frameworks, ranging from minority stress theory to positive youth development, to devise interventions that target isolation and connectedness in schools, community-based organisations, and in online environments. Finally, we discuss the importance of addressing social, cultural, and structural dimensions of social isolation in order to foster enabling environments that allow LGBTQ youth to thrive. This conceptual review suggests that individual and social transformations are the result of young people's meaningful participation in shaping their environment, which is made possible when their capabilities are fostered through social well-being. Our findings suggest the need for measures of social isolation among youth in databanks produced by global institutions, such as the World Health Organization.

Social isolation and connectedness as determinants of well-being: Global evidence mapping focused on LGBTQ youth.

Introduction : Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations. Objective : In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages. Methods : We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular. Results and discussion : Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations’ practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure. Conclusions : Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission. Keywords: HIV; key populations; combination prevention; pre exposure prophylaxis. To access the supplementary material to this article please see Supplementary Files in the column to the right (under Article Tools). (Published: 26 February 2015) Citation: Pettifor A et al. Journal of the International AIDS Society 2015, 18(Suppl 1) :19434 http://www.jiasociety.org/index.php/jias/article/view/19434 | http://dx.doi.org/10.7448/IAS.18.2.19434

https://onlinelibrary.wiley.com/doi/pdf/10.7448/IAS.18.2.19434

Tailored combination prevention packages and PrEP for young key populations

Introduction and Aims
Research highlights that lesbian, gay, bisexual and transgender (LGBT) people use alcohol and drugs (AOD) more than heterosexual people; however, the incidence of AOD use by LGBT youth is less understood. The purpose of the current study was to ascertain AOD prevalence rates for LGBT youth compared with the Australian youth population; perceptions of AOD use within the LGBT community; and the impact of homophobia on AOD use.

Design and Methods
The study surveyed a cross-sectional sample of LGBT youth (13–24 years) (n = 161) who attended a LGBT festival in Brisbane, Australia, in 2012. The Alcohol Use Disorders Identification Test-Consumption, Fagerstrom Test for Nicotine Dependence and Drug Check Assessment Tool were utilised to examine patterns of AOD use, with items developed to explore perceptions of AOD use and homophobia.

Results
AOD use was common among the LGBT sample, with higher prevalence rates compared with the general Australian youth population (2010 National Drug Strategy Household Survey). AOD use by under 18-year-olds, and gender diverse youth was markedly higher. The majority misperceived AOD use to be the same in the LGBT and heterosexual communities. Those who believed homophobia impacted on AOD use were significantly more likely to use AOD.

Discussion and Conclusions
The higher prevalence of AOD use strongly suggests the need for AOD agencies to better respond to LGBT youth by not only screening sexuality and gender identity but also exploring young people's perceptions of AOD use in the LGBT community and their experiences of homophobia in order to provide effective AOD clinical treatment. [Kelly J, Davis C, Schlesinger C. Substance use by same sex attracted young people: Prevalence, perceptions and homophobia. Drug Alcohol Rev 2015;34:358–365]

Substance use by same sex attracted young people: Prevalence, perceptions and homophobia.

Regarded as a normative component of development, risk-taking by young people is a well-researched subject, and some risk-taking behaviours, such as substance use, are particularly well covered because of their potential to adversely affect health and wellbeing. What has remained unclear is the extent of young people's risk-taking while engaged in alcohol and other drug (AOD) treatment, their awareness of the related harms of risk-taking behaviours, and their prior help-seeking for these harms - information which may have a significant impact on the quality and relevance of the care they receive. This paper reports the findings from a brief pilot study exploring those factors in a clinical sample of young people engaged in ongoing AOD counselling.

Risk-taking, harm and help-seeking: Reported by young people in treatment at a youth alcohol and drug counselling service

Introduction and aims Youth work specialises in helping vulnerable young people face life challenges during critical stages of their development. It is a complex and demanding role and factors influencing occupational stress in youth workers are rarely investigated. This study examined whether youth alcohol and other drug workers with greater compassion satisfaction, self-care practice and self-care agency experienced different rates of occupational stress including burnout and secondary traumatic stress. Design and methods A convenience sample of 258 Australian youth alcohol and other drug workers completed an online questionnaire battery. A four-stage data analysis was conducted utilising multivariate analysis of variance, bivariate correlations, linear multiple regression models and mediation modelling. Results Burnout and secondary traumatic stress exhibited moderate negative correlations with compassion satisfaction, self-care practice and the different forms of self-care agency. Further, a decrease in lacking power for self-care, a form of self-care agency, was the strongest contributor to both burnout and secondary traumatic stress. Support was found for a mediation pathway whereby self-care agency led to greater self-care practice, which in turn increased compassion satisfaction, lowering burnout and secondary traumatic stress. Discussion and conclusions The findings suggest that it would be beneficial for self-care agency to be a key focus of youth worker training and professional development programs.

Self-care agency and self-care practice in youth workers reduces burnout risk and improves compassion satisfaction

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Substance use by same sex attracted young people: Prevalence, perceptions and homophobia.

Risk-taking, harm and help-seeking: Reported by young people in treatment at a youth alcohol and drug counselling service

Self-care agency and self-care practice in youth workers reduces burnout risk and improves compassion satisfaction