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Introduction: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co‐occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. Design/Methods: Partial least square path modeling followed by response‐based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)‐based TW (N = 1418; 46.2% White non‐Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post‐traumatic stress and psychological distress). Results: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. Conclusion: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co‐occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real‐world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti‐racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. Clinical Relevance: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post‐traumatic stress disorder and psychological distress. Specifically, interventions should take an anti‐racist approach and would benefit from incorporating social support‐building activities. [ABSTRACT FROM AUTHOR]

Introduction: Transgender women in the United States experience high HIV incidence and suboptimal Pre‐exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women. Methods: Using a sequential, explanatory, mixed‐methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow‐up 24 months; interquartile range 15–36). Cox regression models assessed predictors of initiation and discontinuation. In‐depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta‐inferences and facilitate the interpretation of findings. Results: 21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person‐years (6.5 initiations/100 person‐years, 95% CI: 5.5–7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP‐indicated was 9.6 initiations/100 person‐years (132/1372 person‐years; 95% CI: 8.1–11.4). We observed 138 PrEP discontinuations over 368 person‐years (37.5 discontinuations/100 person‐years, 95% CI: 31.7–44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk. Conclusions: PrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence‐based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population. [ABSTRACT FROM AUTHOR]

Background: Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. Methods: This online, cross‐sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. Results: BSMW (n = 101) had the highest prevalence of care delays with 5.17‐fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43‐fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. Conclusions: Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum. Black sexual minority women are 5 times more likely to have delays in breast cancer care than White heterosexual women. Experiences of intersectional stigma increase the odds of a care delay, whereas social support decreases the odds of a care delay. [ABSTRACT FROM AUTHOR]

An introduction to the special issue of the "Journal of the International AIDS Society," focusing on the theme of health intervention for transgender people affected by HIV and AIDS," is presented.

An introduction to this issue of the "Journal of the International AIDS Society" focusing on HIV epidemics among transgender people, is presented.

Keywords: transgender women; sub-Saharan Africa; HIV; key populations EN transgender women sub-Saharan Africa HIV key populations 1 2 2 02/05/21 20210101 NES 210101 We were excited to the see the publication of the I JIAS i Supplement entitled, "Engagement of African men and transgender women who have sex with men in HIV research." Perez-Brumer et al. identify how inclusion of HIV prevalence data from transgender women with MSM, artificially increases the reported prevalence among MSM as it simultaneously renders the elevated prevalence among transgender women invisible [5]. 4 Poteat T, German D, Flynn C. The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. [Extracted from the article]

Keywords: homophobia; transphobia; biphobia; HIV; stigma; violence EN homophobia transphobia biphobia HIV stigma violence 1 2 2 05/30/20 20200501 NES 200501 Sixteen years ago, Louis Georges Tin, advocate for Black and lesbian, gay, bisexual, transgender and intersex (LGBTI) rights, launched an appeal for universal recognition of May 17 as the International Day Against Homophobia to honour the World Health Organization's decision to remove homosexuality from their list of mental disorders in 1990 [[1]]. Homophobia, transphobia, biphobia, HIV, stigma, violence. [Extracted from the article]