Skip to main content

Advertisement

SpringerLink
Log in

Using a Two-Step Method to Measure Transgender Identity in Latin America/the Caribbean, Portugal, and Spain

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54 %; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Altemus, M. (2006). Sex differences in depression and anxiety disorders: Potential biological determinants. Hormones and Behavior, 50, 534–538. doi:10.1016/j.yhbeh.2006.06.031.

    Article  PubMed  Google Scholar 

  • Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.

    PubMed  Google Scholar 

  • Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. Lancet Infectious Diseases, 13, 214–222. doi:10.1016/S1473-3099(12)70315-8.

    Article  PubMed  Google Scholar 

  • Bauer, G. R., Travers, R., Scanlon, K., & Coleman, T. A. (2012). High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: A province-wide respondent-driven sampling survey. BMC Public Health, 12, 292. doi:10.1186/1471-2458-12-292.

    Article  PubMed Central  PubMed  Google Scholar 

  • Biello, K. B., Rosenberger, J. G., Novak, D. S., Robertson, A. M., Mayer, K. H., & Mimiaga, M. J. (2014). Epidemiology of sexual health in the virtual environment: A multinational online survey of Spanish- and Portuguese-speaking men who use an internet sexual networking site. AIDS and Behavior. doi:10.1007/s10461-014-0844-6.

  • Bockting, W. O. (2008). Psychotherapy and the real-life experience: From gender dichotomy to gender diversity. Sexologies, 17, 211–224. doi:10.1016/j.sexol.2008.08.001.

    Article  Google Scholar 

  • Bockting, W. O. (2009). Transforming the paradigm of transgender health: A field in transition. Sexual and Relationship Therapy, 24, 103–107. doi:10.1080/14681990903037660.

    Article  Google Scholar 

  • Bockting, W. O., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38, 688–701. doi:10.1007/s10508-009-9489-3.

    Article  PubMed  Google Scholar 

  • Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951. doi:10.2105/AJPH.2013.301241.

    Article  PubMed Central  PubMed  Google Scholar 

  • Caceres, C. F., Konda, K., Segura, E. R., & Lyerla, R. (2008). Epidemiology of male same-sex behaviour and associated sexual health indicators in low- and middle-income countries: 2003–2007 estimates. Sexually Transmitted Infections, 84, i49–i56. doi:10.1136/sti.2008.030569.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chen, S., McFarland, W., Thompson, H. M., & Raymond, H. F. (2011). Transmen in San Francisco: What do we know from HIV test site data? AIDS and Behavior, 15, 659–662. doi:10.1007/s10461-010-9859-9.

    Article  PubMed  Google Scholar 

  • Chesney, M. A., Koblin, B. A., Barresi, P. J., Husnik, M. J., Celum, C. L., Colfax, G., … EXPLORE Study Team. (2003). An individually tailored intervention for HIV prevention: Baseline data from the EXPLORE Study. American Journal of Public Health, 93, 933–938. doi:10.2105/AJPH.93.6.933.

  • Clark, J., Salvatierra, J., Segura, E., Salazar, X., Konda, K., Perez-Brumer, A., … Coates, T. (2013). Moderno love: Sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima, Peru. AIDS and Behavior, 17, 1313–1328. doi:10.1007/s10461-012-0210-5.

  • Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921.

    Article  PubMed Central  PubMed  Google Scholar 

  • Conron, K. J., Landers, S. J., Reisner, S. L., & Sell, R. (2014). Sex and gender in the U.S health surveillance system: A call to action. American Journal of Public Health, 104, 970–976. doi:10.2105/AJPH.2013.301831.

  • Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. (2012). Transgender health in Massachusetts: Results from a household probability sample of adults. American Journal of Public Health, 102, 118–122. doi:10.2105/AJPH.2011.300315.

    Article  PubMed Central  PubMed  Google Scholar 

  • De Santis, J. P. (2009). HIV infection risk factors among male-to-female transgender persons: A review of the literature. Journal of the Association of Nurses in AIDS Care, 20, 362–372. doi:10.1016/j.jana.2009.06.005.

    Article  PubMed  Google Scholar 

  • DeSalvo, K. B., Fan, V. S., McDonell, M. B., & Fihn, S. D. (2005). Predicting mortality and healthcare utilization with a single question. Health Services Research, 40, 1234–1246. doi:10.1111/j.1475-6773.2005.00404.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Dubois-Arber, F., Jeannin, A., Spencer, B., Gervasoni, J.-P., Graz, B., Elford, J., … Van de Laar, M. (2010). Mapping HIV/STI behavioural surveillance in Europe. BMC Infectious Diseases, 10, 290. doi:10.1186/1471-2334-10-290.

  • Feldman, J., & Bockting, W. (2003). Transgender health. Minnesota Medicine, 86, 25–32.

    PubMed  Google Scholar 

  • Grant, J. M., Mottet, L. A., Tanis, J. D., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: The National Center for Transgender Equality and National Gay and Lesbian Task Force. Retrieved from http://www.thetaskforce.org/reports_and_research/ntds.

  • Haig, D. (2004). The inexorable rise of gender and the decline of sex: Social change in academic titles, 1945–2001. Archives of Sexual Behavior, 33, 87–96. doi:10.1023/B:ASEB.0000014323.56281.0d.

  • Hankin, B. L., & Abramson, L. Y. (2001). Development of gender differences in depression: An elaborated cognitive vulnerability-transactional stress theory. Psychological Bulletin, 127, 773–796. doi:10.1037/0033-2909.127.6.773.

    Article  PubMed  Google Scholar 

  • Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., Crepaz, N., & HIV/AIDS Prevention Research Synthesis Team. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12, 1–17. doi:10.1007/s10461-007-9299-3.

  • Iantaffi, A., & Bockting, W. O. (2011). Views from both sides of the bridge? Gender, sexual legitimacy and transgender people’s experiences of relationships. Culture, Health & Sexuality, 13, 355–370. doi:10.1080/13691058.2010.537770.

    Article  Google Scholar 

  • Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academic Press.

    Google Scholar 

  • Kenagy, G. P., & Hsieh, C.-M. (2005). The risk less known: Female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care, 17, 195–207. doi:10.1080/19540120512331325680.

    Article  PubMed  Google Scholar 

  • Koblin, B. A., Chesney, M. A., Husnik, M. J., Bozeman, S., Celum, C. L., Buchbinder, S., … EXPLORE Study Team. (2003). High-risk behaviors among men who have sex with men in 6 US cities: Baseline data from the EXPLORE study. American Journal of Public Health, 93, 926–932.

  • Krieger, N. (2003). Genders, sexes, and health: What are the connections—and why does it matter? International Journal of Epidemiology, 32, 652–657. doi:10.1093/ije/dyg156.

    Article  PubMed  Google Scholar 

  • Lewis, R. J., Derlega, V. J., Berndt, A., Morris, L. M., & Rose, S. (2001). An empirical analysis of stressors for gay men and lesbians. Journal of Homosexuality, 42, 63–88. doi:10.1300/J082v42n01_04.

    Article  PubMed  Google Scholar 

  • Likatavicius, G., Klavs, I., Devaux, I., Alix, J., & Nardone, A. (2008). An increase in newly diagnosed HIV cases reported among men who have sex with men in Europe, 2000–6: Implications for a European public health strategy. Sexually Transmitted Infections, 84, 499–505. doi:10.1136/sti.2008.031419.

    Article  PubMed  Google Scholar 

  • Meier, S. C., Pardo, S. T., Labuski, C., & Babcock, J. (2013). Measures of clinical health among female-to-male transgender persons as a function of sexual orientation. Archives of Sexual Behavior, 42, 463–474. doi:10.1007/s10508-012-0052-2.

    Article  PubMed  Google Scholar 

  • Nemoto, T., Bodeker, B., Iwamoto, M., & Sakata, M. (2013). Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables. AIDS Care, 26, 434–440. doi:10.1080/09540121.2013.841832.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187. doi:10.1146/annurev-clinpsy-032511-143109.

    Article  PubMed  Google Scholar 

  • Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M., et al. (2011). A further assessment of Blanchard’s typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. Archives of Sexual Behavior, 40, 247–257. doi:10.1007/s10508-009-9579-2.

    Article  PubMed Central  PubMed  Google Scholar 

  • Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., et al. (2013). Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons. American Journal of Public Health, 103, 300–307. doi:10.2105/AJPH.2011.300568.

    Article  PubMed Central  PubMed  Google Scholar 

  • Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., et al. (2009). Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons. Journal of Acquired Immune Deficiency Syndromes, 52, 417–421. doi:10.1097/QAI.0b013e3181ab6ed8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., et al. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research, 47, 12–23. doi:10.1080/00224490903062258.

    Article  PubMed  Google Scholar 

  • Operario, D., Soma, T., & Underhill, K. (2008). Sex work and HIV status among transgender women: Systematic review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 48, 97–103. doi:10.1097/QAI.0b013e31816e3971.

    Article  PubMed  Google Scholar 

  • Parker, R. G. (2009). Bodies, pleasures, and passions: Sexual culture in contemporary Brazil. Nashville, TN: Vanderbilt University Press.

    Google Scholar 

  • Reisner, S. L., Conron, K. J., Scout, Nfn, Mimiaga, M. J., Rosenberger, J. G., Novak, D. S., … Austin, S. B. (2014a). Comparing in-person and online survey respondents in the National Transgender Discrimination Survey: Implications for transgender health research in the U.S. LGBT Health, 1, 98–106. doi:10.1089/lgbt.2013.0018.

  • Reisner, S. L., Conron, K. J., Tardiff, K. J., Jarvi, S., Gordon, A. R., & Austin, S. B. (2013). Monitoring the health of gender minority populations: Cognitive of natal sex and gender identity items in a U.S. national cohort of young adults (submitted).

  • Reisner, S. L., Perkovich, B., & Mimiaga, M. J. (2010). A mixed methods study of the sexual health needs of New England transmen who have sex with non-transgender men. AIDS Patient Care and STDs, 24, 501–513. doi:10.1089/apc.2010.0059.

    Article  PubMed Central  PubMed  Google Scholar 

  • Reisner, S. L., White, J. M., Mayer, K. H., & Mimiaga, M. J. (2014b). Sexual risk and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care, 26, 857–864. doi:10.1080/09540121.2013.855701.

    Article  PubMed Central  PubMed  Google Scholar 

  • Rosenberg, M., Schooler, C., & Schoenbach, C. (1989). Self-esteem and adolescent problems: Modeling reciprocal effects. American Sociological Review, 54, 1004–1018. doi:10.2307/2095720.

    Article  Google Scholar 

  • Rowniak, S., Chesla, C., & Rose, C. D. (2011). Transmen: The HIV risk of gay identity. AIDS Education and Prevention, 23, 508–520. doi:10.1521/aeap.2011.23.6.508.

    Article  PubMed  Google Scholar 

  • Sánchez, J., Lama, J. R., Kusunoki, L., Manrique, H., Goicochea, P., Lucchetti, A., … Celum, C. (2007). HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. Journal of Acquired Immune Deficiency Syndromes, 44, 578–585.

  • Sausa, L. A., Sevelius, J., Keatley, J., Iñiguez, J. R., & Reyes, M. (2009). Policy recommendations for inclusive data collection of trans people in HIV prevention, care & services. San Francisco, CA: Center of Excellence for Transgender HIV Prevention, University of California, San Francisco. Retrieved from http://transhealth.ucsf.edu/trans?page=lib-data-collection.

  • Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet, E. J., Brugha, T.S., … Kessler, R. C. (2009). Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 66, 785–795. doi:10.1001/archgenpsychiatry.2009.36.

  • Sevelius, J. (2009). “There’s no pamphlet for the kind of sex I have”: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. Journal of the Association of Nurses in AIDS Care, 20, 398–410. doi:10.1016/j.jana.2009.06.001.

    Article  PubMed Central  PubMed  Google Scholar 

  • Silva-Santisteban, A., Raymond, H. F., Salazar, X., Villayzan, J., Leon, S., McFarland, W., et al. (2012). Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: Results from a sero-epidemiologic study using respondent driven sampling. AIDS and Behavior, 16, 872–881. doi:10.1007/s10461-011-0053-5.

    Article  PubMed  Google Scholar 

  • Suárez-Lozano, I., Fajardo, J. M., Garrido, M., Roca, B., Garvia-Alcalde, M. L., Geijo, P., … Lacalle, J. R. (2002). Epidemiological trends of HIV infection in Spain: Preventative plans have to be oriented to new target populations (Spanish VACH Cohort). AIDS, 16, 2496–2499.

  • Sudman, S., Bradburn, N. M., & Schwarz, N. (1996). Thinking about answers: The application of cognitive processes to survey methodology (1st ed.). San Francisco: Jossey-Bass Publishers.

    Google Scholar 

  • Tabet, S., Sánchez, J., Lama, J., Goicochea, P., Campos, P., Rouillon, M., … Holmes, K. K. (2002). HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men. AIDS, 16, 1271–1277.

  • Tate, C. C., Ledbetter, J. N., & Youssef, C. P. (2013). A two-question method for assessing gender categories in the social and medical sciences. Journal of Sex Research, 50, 767–776. doi:10.1080/00224499.2012.690110.

    Article  PubMed  Google Scholar 

  • The Gender Identity in U.S. Surveillance Group (GenIUSS). (2013). Gender-related measures overview. Los Angeles, CA: The Williams Institute at the University of California Los Angeles School of Law. Retrieved from http://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/geniuss-group-overview-feb-2013/.

  • World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health (No. ISBN 9789241563703). Geneva: Author. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/en/index.html.

  • Wylie, S. A., Corliss, H. L., Boulanger, V., Prokop, L. A., & Austin, S. B. (2010). Socially assigned gender nonconformity: A brief measure for use in surveillance and investigation of health disparities. Sex Roles, 63, 264–276. doi:10.1007/s11199-010-9798-y.

Download references

Acknowledgments

S. B. Austin is supported by the Maternal and Child Health Bureau, Health Resources and Services Administration, training grants MC00001 and Leadership Education in Adolescent Health Project 6T71-MC00009. The authors wish to thank Sarah MacCarthy, Sc.D., for her assistance with Portuguese translation.

Author information

Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Kresge 7th floor, Boston, MA, 02115, USA

    Sari L. Reisner, S. Bryn Austin & Amaya Perez-Brumer

  2. The Fenway Institute Fenway Health, Boston, MA, USA

    Sari L. Reisner, Katie Biello, Amaya Perez-Brumer & Matthew J. Mimiaga

  3. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Katie Biello & Matthew J. Mimiaga

  4. Department of Global and Community Health, George Mason University, Fairfax, VA, USA

    Joshua G. Rosenberger

  5. Division of Adolescent and Young Adult Medicine, Children’s Hospital, Boston, MA, USA

    S. Bryn Austin

  6. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    S. Bryn Austin

  7. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    Sebastien Haneuse

  8. OLB Research Institute, Online Buddies, Inc., Cambridge, MA, USA

    David S. Novak

  9. Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

    Matthew J. Mimiaga

Authors
  1. Sari L. Reisner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katie Biello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joshua G. Rosenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Bryn Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastien Haneuse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amaya Perez-Brumer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David S. Novak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sari L. Reisner.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reisner, S.L., Biello, K., Rosenberger, J.G. et al. Using a Two-Step Method to Measure Transgender Identity in Latin America/the Caribbean, Portugal, and Spain. Arch Sex Behav 43, 1503–1514 (2014). https://doi.org/10.1007/s10508-014-0314-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-014-0314-2

Keywords

Search

Navigation