Identifying factors influencing the uptake of viral illness care in transgender populations
Bibliographic record
Abstract
Background: Transgender (trans) people globally are disproportionately burdened by viral illnesses, particularly human immunodeficiency virus (HIV), human papillomavirus (HPV), and by related comorbidities due to intersecting psychosocial and structural factors that intensify health inequities and exacerbate barriers to comprehensive and gender-affirming health care. Investigating the factors influencing the uptake of viral illness care in trans populations may improve health outcomes and aid in the development of appropriate training and practice guidelines.Objectives: The first manuscript aims to compare the prevalence of disclosure of trans identity, comfort discussing trans identity and trans-specific health care needs, and negative experiences with HIV physicians, among trans women with HIV in Canada. The second manuscript investigates the acceptability of screenings for cancers associated with HPV in trans populations.Methods: Baseline and cross-sectional data from a subset of 54 trans women with HIV from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed. Participants self-reported the disclosure of their trans identity to their family/HIV physicians, their comfort discussing their trans identity and trans-specific health care needs with their family/HIV physicians, and negative experiences with their HIV physicians. The prevalence of disclosure, comfort and negative experiences were reported, and Fisher’s exact tests were performed to determine any association between the gender and training of HIV physicians and self-reported comfort. A scoping review of the literature, adhering to the recommendations of PRISMA, was also performed to answer the research question: “what is the acceptability of screenings for cancers associated with HPV in transgender populations?” The search included MEDLINE, CINAHL, Embase, Web of Science, and Scopus. Articles were reviewed by two independent reviewers, and data was extracted by the primary author to be presented in a narrative summary with accompanying tables.Results: At baseline, of the 54 trans women in CHIWOS, 39 (72.2%) had an HIV care physician defined as a physician who primarily looked after a participant’s HIV medical care in the year preceding. Among this subset, 94.9% had disclosed their trans identity and 82.1% reported feeling comfortable discussing trans-specific health care needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific health care needs. The most prevalent negative trans-specific experience with HIV physicians reported at baseline was being told by the physician that they did not know enough about trans-related care to provide care (16.7%). Acceptability of cervical and anal cancer screenings varied depending on context and population. Anal cancer screening acceptability in transmasculine and transfeminine populations may be improved by community education, by culturally competent outreach and screening practices, and by encouraging provider recommendations. The acceptability of cervical cancer screening in transmasculine populations was hindered by past negative experiences, pain, and a lack of provider willingness to provide Pap tests and bolstered by the option to self-test and by providing campaigns and screening sites dedicated to transmasculine people. Conclusion: Our results demonstrate the need for comprehensive, trans-specific training for health care providers practicing with trans populations in viral illness settings. The available evidence indicates that gender-affirming viral illness care models may improve retention in HIV care and regular screening for HPV-related cancers in trans populations
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".