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Background Joy is a powerful and necessary counterpoint to the challenges faced by sexual and gender minoritized (SGM) communities. This study explores how SGM young adults of color in Orange County, California, cultivate joy as a form of everyday resistance and well-being in the face of systemic oppression. Methods Drawing on a participatory action research approach, we used PhotoVoice to engage 19 Black, Indigenous, and people of color (BIPOC) SGM young adults as co-researchers. Participants documented and reflected on everyday experiences of joy through photographs and accompanying narratives, which were thematically analyzed. Results Informed by Johansson and Vinthagen’s Everyday Resistance framework, we found that participants engaged in acts of detachment as a strategy for cultivating joy and resisting the demands of neoliberal productivity culture, including expectations of constant self-optimization, emotional endurance, and conformity. Conclusions The study affirms the value of PhotoVoice in capturing the complex interplay between identity, environments, and systemic oppression. Centering joy in public health research can inform more affirming and culturally responsive interventions.

Substance use and HIV epidemics have disproportionately affected sexual and gender minoritized (SGM) communities, with heightened risks among men who have sex with men (MSM) and transgender women of color due to intersecting challenges like poverty, mental health issues, and discrimination. Despite overall declines in substance use and sexual risk behaviors in the general population, these issues persist within SGM communities, exacerbated by stigma and systemic barriers to care. Digital health interventions have emerged as promising tools to address these disparities, offering accessible and stigma-reducing alternatives to traditional care, particularly effective among younger individuals and in underserved areas. This study seeks to examine the social correlates of substance use and sexual risk perception among an online sample of help-seeking MSM and transgender women in San Francisco, California. We recruited 409 help-seeking MSM and transgender women by using social media advertisements on Facebook, Instagram, and Grindr in 2022-2024. Participants provided informed consent and completed a baseline assessment. Utilization of testing resources for HIV and hepatitis was high among the participants (401/409, 98.04% and 360/409, 88.02%, respectively). Knowledge of HIV or other sexually transmitted infection health services was also high (379/409, 92.67%). Fewer participants (264/409, 64.55%) were knowledgeable about substance use-related services. Although many participants reported that using substances posed a high risk of harm, some perceived engaging in condomless sex, using prescription opioid drugs without a prescription, and using substances during sex as low risk (122/409, 29.83%, 41/409, 10.02%, and 60/409, 14.67%, respectively). Participants who reported experiencing unstable housing were more likely to report perceiving sharing needles (adjusted odds ratio [aOR] 7.20, 95% CI 1.99-27.80) and nonprescription opioid use (aOR 4.02, 95% CI 1.08-14.90) as low risk. Participants who reported an income below the federal poverty level were more likely to report perceiving sharing needles (aOR 6.35, 95% CI 1.84-23.40), prescription opioid use (aOR 2.89, 95% CI 1.32-6.18), and substance use during sex (aOR 2.29, 95% CI 1.14-4.48) as low risk. Participants who have not been tested for hepatitis in the past have 3.31 times the odds of perceiving prescription opioid use as low risk compared to counterparts who have been tested for hepatitis before (95% CI 1.36-7.68). This study underscores the importance of social determinants in shaping low risk perception of the harm associated with substance use behaviors among online help-seeking SGM people in San Francisco. These systemic inequities structure participants' perceptions, access, and utilization of preventive and public health services. Our findings identify critical opportunities for outreach and preventative efforts needed to serve vulnerable populations.

This research letter characterizes racial/ethnic disparities in polysubstance use among 409 online help–seeking sexual and gender minoritized people in San Francisco. Findings demonstrate the central role of tobacco as a co-occurring substance for participants who are Black, Indigenous, and people of color compared to their White counterparts.

We examined PrEP awareness and use among people who inject drugs (PWID) in San Francisco in 2018. Of 397 respondents not known to be HIV positive, 56.7% had heard of PrEP, 38.9% knew that PrEP can prevent HIV transmission from sharing injection equipment, 13.6% had discussed PrEP with a health care provider, and 3.0% had used PrEP in the last 12 months. All seven male PWID who had used PrEP were also men who had sex with men. There is urgent need to improve messaging on PrEP’s effectiveness for PWID and to tailor ways of engaging PWID in PrEP programs.

Young transgender women (trans women) experience poor health in part due to discrimination. Factors that promote resilience may help young trans women positively adapt to discrimination, resulting in attenuation of poor health outcomes. While religion is sometimes a source of stigma and transphobia, qualitative studies have identified religiosity as an important resilience resource for young trans women. The goals of this study were to quantitatively measure religiosity and resilience among young trans women and to assess whether they are associated. From 2012-2013, 300 young trans women between the ages of 16-24 years were enrolled in a longitudinal study; we examined the cross-sectional baseline data on demographics, religiosity, and resilience. Bivariate and multivariable logistic regression analysis examined the correlation between demographics (age, gender, race/ethnicity, education, income) and religiosity among young trans women. Additionally, bivariate and multivariable logistic regression analysis examined the association between religiosity and resilience among young trans women, controlling for age, gender, race/ethnicity, education, and income. Participants who reported high religiosity had significantly greater odds (aOR 1.78, 95% CI 1.05-3.01, p = .03) of reporting high resilience compared to those reporting low religiosity. Black/African American participants had significantly higher odds (aOR 6.16, 95% CI 2.34-16.20, p = < .001) of reporting high religiosity compared to those who identified as White. Religiosity may be an important resilience resource for young trans women. Gender affirming religious and spiritual interventions may promote resilience among some young trans women.

Transgender women face a serious risk of HIV infection. Despite this, there is limited knowledge and use of Pre-exposure prophylaxis (PrEP). We measured the continuity of prevention across services in the PrEP cascade and correlates of PrEP use among trans women in San Francisco enrolled in the 2019/20 National HIV Behavioral Surveillance Study. Knowledge and use of PrEP among trans women in San Francisco increased in recent years; almost all (94.0%) had heard about PrEP, 64.7% had discussed PrEP with a healthcare provider, and 44.8% had taken PrEP in the past 12 months. PrEP use was associated with participation in a PrEP demonstration project (aOR = 31.44, p = 0.001) and condomless receptive anal intercourse (aOR = 3.63, p = 0.024). Injection drug use was negatively associated (aOR = 0.19, p = 0.014). Efforts are needed to combat the gender-based stigma and discrimination faced by trans women, which can result in avoidance and mistrust of the medical system.

China’s national guidelines call for increasing HIV pre-exposure prophylaxis (PrEP) use to reverse the epidemic in populations at highest risk. However, few data exist on PrEP awareness and willingness among trans women in China. Our research aim was to fill this data gap through a cross-sectional survey among trans women in Nanjing and Suzhou cities of Jiangsu province. Respondent-driven sampling (RDS) was used to recruit participants to gauge their awareness of and willingness to use PrEP. Logistic regression analysis was used to characterize associations with awareness of PrEP and willingness to use PrEP. Of 222 HIV-negative/unknown serostatus trans women, 33.3% were aware of PrEP and 49.1% were willing to use PrEP. PrEP awareness was associated with a university degree or above (adjusted odds ratio [AOR] 2.77, 95% CI 1.31–5.89) and not using alcohol with sex (AOR 2.02, 95% CI 1.00–4.09). Willingness to use PrEP was higher among trans women with one (AOR 3.56, 95% CI 1.68–7.54) or multiple sexual partners (AOR 2.53, 95% CI 1.24–5.15) compared to those with no partners. This study witnessed low awareness of PrEP, yet substantial willingness to use PrEP. Implementation research to identify ways to promote, scale up access, and assess effectiveness of PrEP for trans women is urgently needed in China.

Background To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community. Methods Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman. Results Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016. Conclusion Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.

Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. Methods From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses ( N  = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. Results About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of “other” race/ethnicities (25.0%) reported a higher prevalence of sexual assault ( p  = 0.001). Having one’s gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. Conclusions A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.

This research letter examines sex work and substance use associations in a sample of sexual and gender minoritized individuals recruited online in San Francisco, California. This study found that a history of sex work was prevalent and that people with a history of sex work were more likely to recently report using controlled substances and experience domestic violence.