Vagus nerve-driven microbiota homeostasis: a promising integrative add-on therapy for neurodevelopmental disorders.
Authors: Azabou E, Frouin PY, Bellaïche M, Duff I, Bao G, Pillot A, Mehlal S, Bergounioux J, Staats PS, Rangon CM
Journal: Frontiers in neuroscience
PTSD treatment
mental health
open access
Abstract
HIV disproportionately burdens transgender women of color (TWOC) in the
United States. One in five transgender women overall are living with HIV, over 34
times the rate in the general US population (; ). Among Black and Latina transgender women, HIV prevalence is
estimated to be even higher, at around 44% and 28%, respectively (). These inequities are rooted in the
intersectional oppressions that impair the lives of TWOC, including racism,
transphobia, and misogyny (;
). Consequently, a
range of multi-level determinants increase vulnerability to HIV in this population,
and we explore these using a social ecological model (; ). Structural factors impacting HIV prevalence in TWOC include high
rates of poverty, housing instability, food insecurity, sex work, and incarceration
(; ; ; ; ).
Interpersonal factors also contribute to HIV vulnerability: experiences of
healthcare provider insensitivity or ignorance of transgender health, alongside
language barriers in the healthcare setting, have been associated with lower
engagement with HIV preventive care among TWOC (; ; ). While HIV pre-exposure prophylaxis (PrEP) can be an effective HIV prevention
method, uptake and consistent use are suboptimal among TWOC (). Because of the elevated prevalence
and incidence rate of HIV among TWOC, the CDC recommends that all TWOC without HIV
be on PrEP to prevent HIV infection (). Current estimates of use among TWOC range from 15–32%
(; ; ). Given this, it is crucial to understand the
factors influencing PrEP uptake (or lack thereof) in this population. Previous
research has found that TWOC experience increased discrimination in attempting to
access, and while accessing, healthcare compared to white transgender women. This
results in their avoidance of the medical system due to anticipated discrimination
(; ; ). Qualitative research demonstrates that cultural
mistrust of medicine is a barrier to PrEP use among Black and Latina transgender
women (; ). In addition, some transgender women
voice concerns about potential interactions between gender-affirming hormone therapy
(GAHT) and PrEP. These concerns may lower their willingness to use PrEP (; ; ; ; ; ) and have resulted in some
transgender women discontinuing PrEP (). Use of GAHT by transgender women is high: national estimates reported a
prevalence of 72% in 2019–2020 (). Some researchers have found that access to gender-affirming
care facilitates PrEP uptake (; ; ), and most transgender
women are currently taking GAHT prescribed by a healthcare provider (). Positive experiences with
gender-affirming, trans-competent providers make individuals feel more empowered
about their own healthcare and more comfortable discussing and initiating PrEP
(; ). However, we lack evidence on
characteristics associated with PrEP use amongst TWOC taking GAHT that could inform
interventions to increase PrEP uptake.
United States. One in five transgender women overall are living with HIV, over 34
times the rate in the general US population (; ). Among Black and Latina transgender women, HIV prevalence is
estimated to be even higher, at around 44% and 28%, respectively (). These inequities are rooted in the
intersectional oppressions that impair the lives of TWOC, including racism,
transphobia, and misogyny (;
). Consequently, a
range of multi-level determinants increase vulnerability to HIV in this population,
and we explore these using a social ecological model (; ). Structural factors impacting HIV prevalence in TWOC include high
rates of poverty, housing instability, food insecurity, sex work, and incarceration
(; ; ; ; ).
Interpersonal factors also contribute to HIV vulnerability: experiences of
healthcare provider insensitivity or ignorance of transgender health, alongside
language barriers in the healthcare setting, have been associated with lower
engagement with HIV preventive care among TWOC (; ; ). While HIV pre-exposure prophylaxis (PrEP) can be an effective HIV prevention
method, uptake and consistent use are suboptimal among TWOC (). Because of the elevated prevalence
and incidence rate of HIV among TWOC, the CDC recommends that all TWOC without HIV
be on PrEP to prevent HIV infection (). Current estimates of use among TWOC range from 15–32%
(; ; ). Given this, it is crucial to understand the
factors influencing PrEP uptake (or lack thereof) in this population. Previous
research has found that TWOC experience increased discrimination in attempting to
access, and while accessing, healthcare compared to white transgender women. This
results in their avoidance of the medical system due to anticipated discrimination
(; ; ). Qualitative research demonstrates that cultural
mistrust of medicine is a barrier to PrEP use among Black and Latina transgender
women (; ). In addition, some transgender women
voice concerns about potential interactions between gender-affirming hormone therapy
(GAHT) and PrEP. These concerns may lower their willingness to use PrEP (; ; ; ; ; ) and have resulted in some
transgender women discontinuing PrEP (). Use of GAHT by transgender women is high: national estimates reported a
prevalence of 72% in 2019–2020 (). Some researchers have found that access to gender-affirming
care facilitates PrEP uptake (; ; ), and most transgender
women are currently taking GAHT prescribed by a healthcare provider (). Positive experiences with
gender-affirming, trans-competent providers make individuals feel more empowered
about their own healthcare and more comfortable discussing and initiating PrEP
(; ). However, we lack evidence on
characteristics associated with PrEP use amongst TWOC taking GAHT that could inform
interventions to increase PrEP uptake.