1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
My work straddles these generations of research. Regarding first and second, I'm particularly interested in investigating if there is a disparity in endometrial and gynecologic diseases among transgender people and those people using testosterone. The physiology of high-dose longterm testosterone administration to people with a uterus and ovaries is not well described and another goal of my work is to understand the mechanism by which gender affirming testosterone therapy exerts its effects on the gynecologic organs.
The author and health practitioner Yolo Akili has written, "one day ya'll gonna realized forced gender socialization is a public health emergency." Unpacking the gendered expectations for our bodies and life roles, and how this intersects with other identities, will be important to understand why women, transgender, and gender nonconforming people continue to experience health disparities. For transgender people, the health system has pathologized gender deviation as something to be fixed by more closely aligning trans bodies to cisgender bodies. This exposes people to the potential risk of undesired/unnecessary medical and surgical interventions, sometimes non consensually. While gender affirming medical/surgical care may be desirable for many people, the rigid enforcement of gendered norms in our expectations of well-being will always perpetuate gender-based disparities. We need investigation and rapid change of medicine's participation in the production, enforcement and validation of such gendered norms.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
There is a disproportionate burden of HPV and HIV infection in transgender communities, both significantly associated with risk of cervical dysplasia and cancer. While trans people are less likely to present for routine age-based screening, clinicians are also less likely to offer these services to trans people. Another well described health disparity is in the unintended pregnancy rate in young LGBT people. One etiologic factor to these outcomes is increased homelessness and engagement with sex work among trans people. Assessing for housing instability and provision of free or low cost housing to trans young people is one potential intervention to address these disparities. This could be incorporated into clinics already serving this population. The development of culturally appropriate and acceptable screening methods for cervical dysplasia among trans people is another intervention. Investigation into the utility of self-collect HPV swabs is one proposed intervention. This intervention needs investigation on its sensitivity/specificity compared to regular provider administered swabs and if it would increase screening.