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BackgroundIntimate partner violence (IPV) is approximately twice as prevalent among transgender and gender diverse individuals (those whose current gender identity does not match their sex assigned at birth) than among cisgender individuals (those whose gender aligns with their sex assigned at birth). However, most existing scales measuring IPV are not validated among transgender and gender diverse populations and do not consider the unique forms of IPV experienced by transgender and gender diverse individuals. ObjectiveThis paper describes the protocol for Project Empower, a study that seeks to develop and validate a new scale to measure IPV as experienced by transgender and gender diverse adults. A new scale is necessary to improve the accuracy of IPV measurement among transgender and gender diverse populations and may inform the current tools used to screen and link to services for transgender and gender diverse adults who experience or perpetrate IPV. MethodsThe proposed new scale will be developed by a linear three-phase process. In Phase I, we will recruit a maximum of 110 transgender and gender diverse participants to participate in in-depth interviews and focus groups. Phase I will collect qualitative data on the experiences of IPV among transgender and gender individuals. After generating scale items from the qualitative data in Phase I, Phase II will conduct up to 10 cognitive interviews to examine understanding of scale items and refine wording. Phase III will then conduct a survey with an online recruited sample of 700 transgender and gender diverse individuals to validate the scale using factor analysis and examine the prevalence, antecedents, and linked health outcomes of IPV. This study will generate the first comprehensive IPV scale including trans-specific IPV tactics that has undergone robust mixed-methods validation for use in transgender and gender diverse populations, regardless of sex assigned at birth. ResultsProject Empower launched in August 2019, with Phases I and II expected to be complete by late 2020. Phase III (survey of 700 transgender individuals) is expected to be launched in January 2021. ConclusionsA scale that more accurately captures the forms of IPV experienced by transgender and gender diverse people not only has the potential to lead to more accurate measurements of prevalence but also can identify unique forms of violence that may form the basis of IPV prevention interventions. Additionally, identifying the forms of IPV experienced by transgender and gender diverse people has the potential to lead to the refinement of clinical screening tools used to identify and refer those who experience and perpetrate violence in clinical settings. International Registered Report Identifier (IRRID)DERR1-10.2196/23819

Stress arising from the experience of stigma and discrimination around gender identity is known to negatively influence health outcomes for transgender individuals. The Gender Minority Stress and Resilience (GMSR) scale is a validated tool for measuring experiences of minority stress and resilience among transgender individuals. This paper seeks to examine whether there are differences in how youth respond to the GMSR scale. Using data from a sample of 202 transgender and gender nonbinary youth collected online, this analysis compares responses to the GMSR scale between transgender youth with binary and nonbinary gender identities. While reports of non-affirmation were generally high (M = 15.02), and community connectedness for all participants was generally low (M = 7.5), there were no significant differences to scale responses across gender identity. Nonbinary assigned male at birth (AMAB) reported greater rates of threats of physical violence due to gender identity or expression. Nonbinary assigned female at birth (AFAB) reported greater rates of feeling unique in their gender identity or expression. This preliminary analysis suggests that the GMSR scale is a useful tool, however, further research is needed to understand stress and resilience among transgender and gender nonbinary youth and developing specific measures that capture their experience.

We adapted the Sexual Experiences Survey (SES) to be more inclusive of transgender, nonbinary, and gender-expansive people and undertook preliminary validation of the measure. We added gender-neutral language, assault types thought to be more common and more emotionally impactful among these individuals, and coercion tactics specific to transgender, nonbinary, and gender-expensive people. We piloted this Gender-Inclusive SES (GI-SES) with an online survey of transgender and gender-expansive undergraduates who experienced campus sexual assault. We assessed acceptability via rapid qualitative analysis of feedback. We gathered preliminary evidence of validity by calculating the agreement in assault type and coercion tactic between open-ended descriptions of the assault and the GI-SES response, as well as by testing four hypotheses about the relative frequency and severity of different types of assaults within the sample. Three hundred eighty-eight transgender, nonbinary, and gender-expensive students completed the survey. Qualitative responses indicated that participants felt the GI-SES was inclusive and respectful. Results were partially consistent with hypotheses supporting validity, and there was 90.9% agreement in assault type and 85.9% agreement in coercion tactics between GI-SES responses and written narratives. The GI-SES provides researchers, clinicians, and service providers with a tool, preliminarily validated with a trans and gender-diverse college sample, to capture the unique experiences of transgender, nonbinary, and gender-expensive sexual assault survivors. [ABSTRACT FROM AUTHOR]

Transgender (trans) women experience barriers to access to HIV care, which result in their lower engagement in HIV prevention, treatment and support relative to cisgender people living with HIV. Studies of trans women's barriers to HIV care have predominantly focused on perspectives of trans women, while barriers are most often described at provider, organisation and/or systems levels. Comparing perspectives of trans women and service providers may promote a shared vision for achieving health equity. Thus, this qualitative study utilised focus groups and semi‐structured interviews conducted 2018–2019 to understand barriers and facilitators to HIV care from the perspectives of trans women (n = 26) and service providers (n = 10). Barriers endorsed by both groups included: (a) anticipated and enacted stigma and discrimination in the provision of direct care, (b) lack of provider knowledge of HIV care needs for trans women, (c) absence of trans‐specific services/organisations and (d) cisnormativity in sexual healthcare. Facilitators included: (a) provision of trans‐positive trauma‐informed care, (b) autonomy and choice for trans women in selecting sexual health services and (c) models for trans‐affirming systems change. Each theme had significant overlap, yet nuanced perspective, between trans women and service providers. Specific recommendations to improve HIV care access for trans women are discussed. These recommendations can be used by administrators and service providers alike to work collaboratively with trans women to reduce barriers and facilitators to HIV care and ultimately to achieve health equity for trans women. [ABSTRACT FROM AUTHOR]