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: Introduction: Internationally, trans women are disproportionately impacted by HIV, encounter specific barriers navigating safer sex and face inequities accessing HIV prevention, including pre‐exposure prophylaxis (PrEP). Aotearoa/New Zealand (hereafter Aotearoa) was one of the first countries internationally to publicly fund PrEP in 2018, including for trans people. However, few data exist on PrEP awareness or sexual negotiation among trans populations to guide implementation. We present the first Aotearoa data on trans people's ability to negotiate barrier protection and awareness of PrEP efficacy and availability. Methods: We used data from a large, diverse community‐based nationwide survey of trans (including non‐binary) people in Aotearoa: Counting Ourselves (N = 1178) conducted from 21 June to 30 September 2018. Generalized regression analyses were carried out among participants who have had sex (n = 704; M[sub.age] = 32.5) to identify associations between demographic factors (age, gender and sexual attraction, ethnicity, income, education qualification and current sex work involvement) and the Trans‐Specific Barrier Negotiation Self‐Efficacy (T‐Barrier) Scale and PrEP awareness. Results: The mean value of a 40‐point T‐Barrier Scale was 33.45 (SD: 6.89), suggesting a relatively high perceived ability among our participants to negotiate protective barrier usages in different situations. Asian participants scored 3.46 points lower compared to Pākehā (White) participants, and trans women attracted to men (cisgender and/or trans men) scored 2.40 points higher than trans women not attracted to men. Three‐fifths (59.7%) were aware that PrEP reduced HIV risks and did not prevent sexually transmitted infections (STI) transmission, and only two‐fifths (40.2%) knew PrEP was publicly funded for trans people. In multivariate models, we found participants who were older, trans women or those with lower education qualifications were less likely to have increased levels of PrEP awareness. Conclusions: Participants attracted to men have a higher potential need for PrEP and were more likely to report PrEP awareness and that they could negotiate protective barrier usage. However, trans women and those with lower educational qualifications reported lower levels of PrEP awareness. More trans‐competent sexual health education, drawing on the newly released PrEP guidelines, is needed to promote the benefits of PrEP in the Aotearoa HIV epidemic context, particularly for trans women., INTRODUCTION Initial international data specific to transgender (trans) people demonstrate a heavy burden of HIV among trans women, specifically trans women who have sex with men [1]. HIV inequities persist [...]

Background Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. Methods Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14–26 years; n  = 608; M age = 20.5). Results Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02–3.98) of having attempted suicide in the last 12 months. Conclusions Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth. [ABSTRACT FROM AUTHOR]

Objective: To examine the issues of primary care access and foregone health care among transgender adolescents and young adults.Methods: This cross-sectional analysis of data from the Canadian Trans Youth Health Survey was conducted online during 2013-2014. Participants included 923 youth aged 14-25 (323 adolescents aged 14-18 and 600 young adults aged 19-25). Main outcome measures were self-reported general and mental health status, comfort discussing transgender identity and health care needs with general practitioners, and types of and reasons for self-identified foregone health care.Results: Most youth reported poor/fair general and mental health status. Comfort with a family doctor was positively correlated with both general health (r(528) = 21, P < 0.001) and mental health (r(450) = 26, P < 0.001) status, as was having a doctor who was aware of one's transgender status. 47.2% (n = 219) of young adults reported foregoing needed health care. Among adolescents, levels of comfort with family doctor were negatively correlated with foregone mental health care in the previous 12 months (F3,166 = 3.829, P = 0.011), but not correlated with foregone physical health care (F3,165 = 0.506, P = 0.679). Reasons for missing needed care spanned the dimensions of health care access, ranging from cost barriers to previous negative experiences with health care providers, and concerns that a doctor would be uneducated about transgender people.Conclusion: General practitioners can play a key role in improving the health of transgender youth by demonstrating understanding of the health care needs of transgender youth and competence in gender-affirming care, and by ensuring that their practices are accessible to all transgender youth in need of care. [ABSTRACT FROM AUTHOR]

Social media is used by many Transgender and Gender-Diverse (TGD) people to access queer communities and social support. However, TGD users are also at a higher risk of online harassment than their cisgender peers. There are few studies which explore the role that social media plays in TGD people's lives. In this study, a qualitative online survey examining online experiences was completed by 52 TGD participants, and the data were analysed using deductive template analysis. The results identified that online communities provided spaces within which participants could experience community-specific support, the validation of their identities, and find much-needed healthcare information. However, the use of social media also exposed participants to transphobia, and the participants described both proactive protective and reactive mitigation behaviours used to deal with these. Key findings highlight the pivotal role that online communities can have for improving wellbeing but also the potential for unintended exposure to transphobia through these communities. The importance of improving online moderation/reporting tools to combat harassment is discussed, as is the need to develop accessible information resources for healthcare professionals so that they may better provide support for TGD patients. [ABSTRACT FROM AUTHOR]

Discrimination and homonegativity have been consistently linked to poorer mental health outcomes in LGBTQI+ individuals. However, little is known about the role of internal shame and the potential moderating role of social support. This cross-sectional study investigated the impact of discrimination, internal shame, and social support on mental health outcomes in LGBTQI+ individuals, exploring the intersection between gender and sexual orientation. LGBTQI+ participants, especially women, reveal higher levels of discrimination and shame and a stronger impact on mental health outcomes compared to heterosexual counter-partners. Internal shame was found to mediate the impact of discrimination on depression and anxiety. Social support was found to buffer the impact of discrimination on internal shame, depression, and anxiety. These findings have important implications for clinical practice with LGBTQI+ individuals, suggesting that addressing internal shame and building social support networks are central to promoting resilience and mental health. Results also highlight that gender and sexual orientation should be considered in an intersectional approach when addressing gender-based violence and discrimination and its impact on mental health. [ABSTRACT FROM AUTHOR]

(1) Background: Fertility preservation allows for trans and non-binary individuals to achieve parenthood using their own gametes. Considering that preservation of gametes can be performed at increasingly earlier ages, it is important to analyze both the attitudes of trans and non-binary youth and their parents towards available family formation options, including fertility preservation. We aimed to explore attitudes toward parenthood and fertility among trans and non-binary youth and parents of trans and non-binary youth. (2) Methods: A questionnaire about fertility attitudes was administered to 33 adolescents and young adults and 27 parents. (3) Results: Trans and non-binary youth showed little interest in resorting to fertility preservation, and both parents and youth mentioned the lack of knowledge about this procedure as the main reason for not performing it. Parents were overall supportive of their children's decisions, including the choice of different pathways to parenthood other than biological reproduction. (4) Discussion: Health providers should ensure that young trans and non-binary persons and their parents are aware of family formation options, including fertility preservation along with its impact in future genetic parenthood. [ABSTRACT FROM AUTHOR]

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Background: Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care. Main body: Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions. Conclusion: There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future. [ABSTRACT FROM AUTHOR]