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Faith-based attitudes impact HIV, say religious leaders & scholars

Religious leaders and scholars from diverse faiths discussed how faith-based attitudes and religious beliefs impact HIV. “Religious leaders and faith communities say that they don’t reject homosexuals, but just don’t be active. This doesn’t make sense,” says Rev. Phumzile Mabizela, executive director of INERELA+.

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This is part of Outrage Magazine‘s coverage of the 2014 International AIDS Conference in Melbourne, Australia.

AIDS 2014

MELBOURNE, AUSTRALIA. At the Interfaith Pre-Conference of the 2014 International AIDS Conference in Melbourne, Australia, religious leaders and scholars from diverse faiths discussed how faith-based attitudes and religious beliefs impact HIV. This is in relation to stigma, discrimination, access to health services, and sexual behavior and identity.

According to Rev. Phumzile Mabizela, executive director of the International Network of Religious Leaders Living with or personally affected by HIV and AIDS (INERELA+), sacred texts that were supposed to give life have stigmatized people living with HIV (PLHIV), men who have sex with men (MSM), and the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community.

“Religious leaders and faith communities say that they don’t reject homosexuals, but just don’t be active. This doesn’t make sense,” Mabizela said.

As such, the Church of Sweden is looking into ways to respond more positively to gender and human sexuality, particularly in the Abrahamic faiths (Judaism, Christianity, and Islam).

“The current mainstream Christian Biblical interpretation lags far behind Jewish biblical interpretation. While much of mainline Christian Biblical interpretation still struggles with the Genesis account of Sodom & Gomorrah, all but the single most conservative Jewish expression today reject the Sodom & Gomorrah account having any reference to homosexuality,” said Rev. Fr. JP Mogkethi-Heath, policy advisor on HIV, Human Sexuality, and Theology of the Church of Sweden.

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For Mogkethi-Heath, “the world still uses words derived from this interpretation of Sodom and Gomorrah; Sodomite, sodomy, et cetera.”

Discussing research presented by K. Renato Lings in his 2013 book “Love lost in Translation”, Mokgethi-Heath showed how poor and inconsistent Biblical translation led to gender disparity.

“Most English translations of the Bible reflect that God removed Adam’s rib and used it to create Eve. But nothing could be further from the truth. The Hebrew in no way uses a word which can even loosely be translated as rib, rather the word means side. In effect, when God took Eve from Adam’s side, God separated the sexes. One could say the first earthling was intersex, and so male has no greater authority that female as both were created together,” Mogkethi-Heath said.

Meanwhile, responding to homophobia and HIV-related stigma of Islamic leaders and faith communities, the Asia Pacific Coalition on Male Sexual Health (APCOM), in its discussion paper on Islam, sexual diversity and access to health services, argued that Islam, in essence, does not condemn anyone due to sexual orientation. The Quran does not prescribe punishments for homosexuality.

“The attitudes of the global Muslim community regarding MSM and transgender people have been strongly influenced by secondary religious sources such as Hadith, Ijima and patriarchal interpretations,” said Dédé Oetomo, chairperson of APCOM.

He added that Islam is very diverse and has different approaches, namely Orthodox, Progressive, and Alternative approaches. In a gist, Orthodox considers MSM and transgender people as unnatural and are abominations and should be punished or sentenced to death.  Remedialist Islam believes that MSMs and transgender people who need help in order to become “normal”.  Progressive Islam believes that MSM and transgender people are unnatural, but also believe that God is the sole judge and that the sin should be hated and not the sinner. Meanwhile, Reformist Progressive Islam believes that MSM are natural, and the Shariah Law needs to reform to accommodate sexual minorities.

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APCOM recommends that human rights organizations, human rights defenders, gender activists and policy makers should support Passivist/Reformist views.

Religious leaders and scholars emphasized that the LGBTI community is part of the faith community.

“It is our business as faith communities to make sure that they continue nourishing and developing their relationship with God, and also that they don’t feel judged just because they are homosexual,” Mabizela said.

INERELA+ is one of the organizations that help LGBTI people and PLHIV embrace “who they are, and help them understand that they were created in the image of God.”

“We help them understand the roots of the stigma that they experience within the faith community. We challenge the attitudes of the faith community by using the sacred texts and help them to understand the rights of the LGBTI and PLHIV community,” Mabizela ended.

A registered nurse, John Ryan (or call him "Rye") Mendoza hails from Cagayan de Oro City in Mindanao (where, no, it isn't always as "bloody", as the mainstream media claims it to be, he noted). He first moved to Metro Manila in 2010 (supposedly just to finish a health social science degree), but fell in love not necessarily with the (err, smoggy) place, but it's hustle and bustle. He now divides his time in Mindanao (where he still serves under-represented Indigenous Peoples), and elsewhere (Metro Manila included) to help push for equal rights for LGBT Filipinos. And, yes, he parties, too (see, activists need not be boring! - Ed).

LIFESTYLE & CULTURE

Not all men idolize Western ideals of muscularity

A study examining attitudes and behaviors among males from three different countries found men in non-Western cultures were less preoccupied with body appearance.

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Photo from Pixabay.com

It turns out that there may be some limits to the influence of Western culture on the rest of the world, after all. A new paper in Frontiers in Psychology that examined men’s attitudes towards and behaviors around muscularity in three countries found than non-Western men were generally less hung up about their body image and pursuing a muscular physique than Western men.

“However, we did still find evidence that men in these populations are influenced by both other men around them and by the media,” said lead author Dr. Tracey Thornborrow at the University of Lincoln in the United Kingdom.

Most of the research on sociocultural influences, like media portrayals that shape male ideals and behaviors around muscularity and masculinity, have focused on so-called WEIRD (Western, Educated, Industrialized, Rich, Democratic) populations. That means many of the conclusions around the drive for muscularity and its negative behaviors, such as steroid use and unhealthy dieting, are very Western-centric.

But men in all populations are influenced by both other men around them and by the media.
Photo by Dollar Gill from Unsplash.com

Thornborrow and the other UK scientists on the team wanted to learn if those attitudes translated to countries with different cultural norms, so they compared a cohort of British men against Ugandan and Nicaraguan males.

The study collected and assessed a number of parameters from each group, ranging from demographics and body mass index (BMI) to feelings about media influences and peer pressure on achieving an idealized appearance to personal body goals.

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Participants also ranked the perceived level of muscularity of their current body and their ideal body on the Male Adiposity and Muscularity Scale (MAMS). Designed by the Person Perception Lab at the University of Lincoln, the new scale uses two-dimensional images created from 3D software, providing a more realistic range of body types and sizes based on measurements of real people.

The researchers also used a form of artificial intelligence to find patterns in that data that might predict which ethnic groups would be driven toward behaviors to achieve more muscle regardless of country of origin.

“We used machine learning methods because they are good at determining if sociocultural factors, such as media and ethnicity, and a drive for muscularity, make it more likely that men will actively want to change their bodies,” said co-author Tochukwu Onwuegbusi, also out of the University of Lincoln, who crunched the numbers on the study.

For example, the data from the current study suggest that being a Caucasian man in the UK or a Miskitu man in Nicaragua means that he would more likely believe that one should be muscular. Such men are more likely to engage in muscle-building activities, such as weight training or drinking protein shakes.

Motivations behind the drive toward a more muscle-bound frame can be complex, Thornborrow noted. For instance, men from certain ethnic groups in Nicaragua who reported being less concerned with physical appearance were still likely to try to increase muscle mass.

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These non-media influenced motivations “could include local ideas about masculinity, and a muscular body being a visual indicator of a working man, not a lazy man,” Thornborrow explained. “In rural Nicaragua, many men will engage in physical work, such as farming, fishing, and construction, so a muscular body is associated with being a hard-working man.”

While there is growing evidence that men in Western countries are experiencing a lot of pressure to conform to stereotypical body ideals, similarly to women, the picture emerging in non-WEIRD populations is less clear. More research is needed to better understand the consequences of these other cultural attitudes and behaviors around body image.

Motivations behind the drive toward a more muscle-bound frame can be complex.
Photo by Amsnel Gorgonio from Unsplash.com

“This study, in particular, shows how there can be variation within groups — for example, nations or ethnic groups — and so it becomes more important to ensure any strategies or interventions are tailored to the specific cultural context,” Thornborrow said.

Weight is a big issue in the LGBTQIA community.

In February 2019, for instance, a study noted that 44% to 70% of LGBTQ teens reported weight-based teasing from family members, 41% to 57% reported weight-based teasing from peers, and as many as 44% reported weight-based teasing from both family members and peers.

Meanwhile, in October 2019, another study noted that weight stigma affects men using dating apps. Specifically, Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. Three out of four gay men are reported to have used Grindr.

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NEWSMAKERS

Lack of media skepticism tied to belief in rape myths

Men were more likely than women to believe three rape myths – that women who are raped were “asking for it”; that men “didn’t mean to rape” but couldn’t help themselves; and that “it wasn’t really rape” unless it was by a stranger.

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Photo by Jen Theodore from Unsplash.com

People who tend to recognize similarities between people they know and people depicted in the media are more likely to believe common myths about sexual assault, according to a new study co-led by a Cornell researcher.

The data, culled from more than 280 interviews with students at eight community colleges in the southeastern United States, suggests that media literacy education could help raise awareness about sexual violence, and improve sexual violence prevention programs on college campuses.

“There is work establishing connections between media that people consume and their beliefs about rape, but less is known about how people make sense of those media messages,” said Kristen Elmore, assistant director of the Program for Research on Youth Development and Engagement in the College of Human Ecology’s Bronfenbrenner Center for Translational Research. “And what we found is that there’s a positive relationship between ‘seeing other people I know in media,’ and beliefs that endorse the myths that women who are raped are ‘asking for it,’ or that men never really intended to do it.”

Elmore is first author of “Rape Myth Acceptance Reflects Perceptions of Media Portrayals as Similar to Others, But Not the Self,” published in the journal Violence Against Women. It was co-authored with researchers at Innovation Research and Training, an independent social sciences research firm in Durham, North Carolina, who conducted the survey in 2015.

“In that dataset was an opportunity to explore these questions about beliefs in rape myths and how they might be related to representations of rape in the media,” Elmore said. “It helps us try to answer a question that many of us have been thinking about since the #MeToo movement began, which is: Where do these myths about rape come from?”

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The researchers asked participants to rate their agreement with 13 statements associated with rape. They then asked them whether people portrayed in various types of media, including music, movies and television, were similar to them, similar to people they knew, or realistic portrayals, and whether they aspired to be like the people depicted in media. The survey also asked about religious background and past experience with dating violence.

They found men were more likely than women to believe three rape myths – that women who are raped were “asking for it”; that men “didn’t mean to rape” but couldn’t help themselves; and that “it wasn’t really rape” unless it was by a stranger. For two of the three rape myths, they found that both men and women were more likely to believe them if they reported seeing similarities between people they knew and people they saw in the media.

The fact that there was no correlation between belief in rape myths and seeing themselves in media could reflect what’s known as “optimism bias,” Elmore said – people’s belief that good things are more likely to happen to them and bad things are more likely to happen to others.

Elmore said that although the study doesn’t show that perceptions of the media cause belief in rape myths, it suggests that depictions of rape in media could shape people’s views.

“If I know something about how people interpret media,” Elmore said, “I can at least predict something about their beliefs about rape, though there may be some third variable influencing both of those things.”

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Because the survey was conducted before most of the recent revelations arising from the #MeToo movement, future work will assess whether portrayals of sexual violence in the media – as well as people’s perceptions of rape myths – have changed for the better, Elmore said.

“We’re at this interesting time where media narratives about sexual assault may be changing in really important ways,” she said, “and there seems to be more space for discussion that challenges common rape myths.”

The study’s co-authors are Tracy Scull, Christina Malik and Janis Kupersmidt of Innovation Research and Training. The work was supported in part by the National Institute on Drug Abuse, part of the National Institutes of Health.

Rape is, of course, a big issue in the LGBTQIA community.

In 2018, for instance, a study found that found that 50% of bisexual women experienced rape at one point of their lifetime, and – at least in the US – approximately 75% reported experiencing sexual violence.

Male members of the LGBTQIA community also reported – even anecdotally – being sexually abused.

In 2017, for instance, Outrage Magazine chatted with a male survivor of sexual assault who was not only violated, but had to contend with “secondary victimization” – i.e. from getting blamed for what happened to him, to his experience being belittled if not actually denied supposedly because only women can be raped.

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NEWSMAKERS

Validation may be best way to support stressed out friends and family

In uncertain times, supporting your friends and family can help them make it through. But your comforting words can have different effects based on how you phrase them.

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In uncertain times, supporting your friends and family can help them make it through. But your comforting words can have different effects based on how you phrase them, according to new Penn State research.

The researchers studied how people responded to a variety of different messages offering emotional support. They found that messages that validated a person’s feelings were more effective and helpful than ones that were critical or diminished emotions.

The findings were recently published in the keystone paper of a virtual special issue of the Journal of Communication. The researchers said the results could help people provide better support to their friends and families.

“One recommendation is for people to avoid using language that conveys control or uses arguments without sound justification,” said Xi Tian, a graduate assistant in communication arts and sciences. “For example, instead of telling a distressed person how to feel, like ‘don’t take it so hard’ or ‘don’t think about it,’ you could encourage them to talk about their thoughts or feelings so that person can come to their own conclusions about how to change their feelings or behaviors.”

Tian said that previous research has shown that social support can help alleviate emotional distress, increase physical and psychological well-being, and improve personal relationships. But — depending on how support is phrased or worded — it could be counterproductive, such as actually increasing stress or reducing a person’s confidence that they can manage their stressful situation.

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Denise Solomon, department head and professor of communication arts and sciences, said they were trying to learn more about why well-intentioned attempts to comfort others are sometimes seen as insensitive or unhelpful.

“We wanted to examine the underlying mechanism that explains why some supportive messages may produce unintended consequences,” Solomon said. “We also wanted to understand how people cognitively and emotionally respond to insensitive social support.”

For the study, the researchers recruited 478 married adults who had recently experienced an argument with their spouse. Before completing an online questionnaire, participants were asked to think about someone with whom they had previously discussed their marriage or spouse. Then, they were presented with one of six possible supportive messages and were asked to imagine that person giving them that message.

Lastly, the participants were asked to rate their given message on a variety of characteristics.

“We manipulated the messages based on how well the support message validates, recognizes, or acknowledges the support recipients’ emotions, feelings, and experiences,” Tian said. “Essentially, the messages were manipulated to exhibit low, moderate, or high levels of person-centeredness, and we created two messages for each level of person-centeredness.”

According to the researchers, a highly person-centered message recognizes the other person’s feelings and helps the person explore why they might be feeling that way. For example, “Disagreeing with someone you care about is always hard. It makes sense that you would be upset about this.” Meanwhile, a low person-centered message is critical and challenges the person’s feelings. For example, “Nobody is worth getting so worked up about. Stop being so depressed.”

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After analyzing the data, the researchers found that low person-centered support messages did not help people manage their marital disagreement in a way that reduced emotional distress.

“In fact, those messages were perceived as dominating and lacking argument strength,” Tian said. “Those messages induced more resistance to social support, such that the participants reported feeling angry after receiving the message. They also reported actually criticizing the message while reading it.”

In contrast, high person-centered messages produced more emotional improvement and circumvented reactance to social support.

“Another recommendation that can be taken from this research is that people may want to use moderately to highly person-centered messages when helping others cope with everyday stressors,” said Solomon.

The researchers said people can try using language that expresses sympathy, care and concern. For example, “I’m sorry you are going through this. I’m worried about you and how you must be feeling right now.” Acknowledging the other person’s feelings or offering perspective — like saying “It’s understandable that you are stressed out since it’s something you really care about” — may also be helpful.

Kellie St.Cyr Brisini, postdoctoral teaching fellow in communication arts and sciences, also participated in this work.

Penn State’s Department of Communication Arts and Sciences helped support this research.

Support – or its lack – is a big issue for members of the LGBTQIA community.

In March, for instance, a study found that community LGBTQ supportiveness was found to be associated with lower odds of lifetime illegal drug use for sexual minority boys and girls and lower odds of lifetime marijuana use and smoking for girls. Living in a large population center was related to lower odds of lifetime alcohol use for boys.

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An earlier study, done in 2019, similarly noted that family acceptance seems to be crucial to ensure that LGB children develop a healthy sense of self while family rejection of LGB children can negatively affect their identity and well-being.

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NEWSMAKERS

With quarantine in place, Pornhub sees surge in traffic

Pornhub’s worldwide traffic was 5.7% higher than usual. Searches with “coronavirus” and “Covid” have also steadily grown since the end of January.

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Photo by @charlesdeluvio from Unsplash.com

It’s still all about sex.

With over a billion people now under quarantine (as of March 25), people are finding ways to… spend their time. And apparently, one of those ways is to enjoy sex, not necessarily engaging in the act but as consumers of what’s available online.

Pornhub reported that nowadays, approximately 120 million people visit its site on a daily basis, with the company noting that “perhaps more interesting, we found that people were choosing to visit Pornhub at different times.”

Wednesdays marked the biggest traffic growth, with the worldwide traffic surging 5.7% higher than usual.

At 2 a.m., traffic was 11% higher than usual, but dipped 9% below average at 8 a.m. This difference was noted by Pornhub because usually, 8 a.m. is one of the most popular times to visit the site. But the change may be because “people who did not need to commute to work the next day stayed up later and slept in longer than they normally would.”

Throughout the day, Pornhub noted that traffic was 11% above average at 1 p.m., then dipped 6% at 4 p.m., with another increase of 8% at 7 p.m.

Here’s an interesting thing: a new kink may be emerging.

Pornhub reported that searches containing “coronavirus” first appeared on January 25 and have continued to grow. In the past 30 days, more than 6.8 million searches containing either ‘corona’ or ‘Covid’ were reported; so enter “Covid porn”.

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NEWSMAKERS

Teens who feel empowered are less likely to bully, harass, commit sexual violence

The findings suggest that bullying, harassment and sexual violence can be reduced when adolescents learn to cope with stress, build community connections, engage with individuals from diverse backgrounds and feel empowered and able to build a positive future.

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Teens who feel personally empowered are less likely to bully, harass or commit acts of sexual violence, according to a study by Rutgers University, the University of Nebraska, and the University of New Hampshire.

The study, published in the Journal of Youth and Adolescence, also found that teens who think their friends support violence prevention and healthy relationships are less likely to mistreat their peers.

“Coping mechanisms that help adolescents thrive and do well, even in the face of stress and adversity, are important to preventing interpersonal violence. This is an important finding, as studies of bullying typically examine risk factors rather than protective factors,” said lead author Victoria Banyard, professor and associate director of the Center on Violence Against Women and Children at the Rutgers School of Social Work.

The findings suggest that bullying, harassment and sexual violence can be reduced when adolescents learn to cope with stress, build community connections, engage with individuals from diverse backgrounds and feel empowered and able to build a positive future.

Adults can help young people develop these strengths, said Banyard. “Positive conversations with teens about healthy relationships support the positive social norms we know are important.”

Adolescence is a high-risk age for perpetration of different forms of peer-based violence including in-person and online bullying, harassment, racial bullying, and unwanted sexual contact, the researchers explained.

The researchers surveyed a set of 2,232 middle and high school students online during the school year by seeking their level of agreement or disagreement with statements including “If I am feeling sad, I can cheer myself up,” “My opinion is important because it could someday make a difference in my community,” “I work hard now to make a good future for myself,” “I am comfortable being with people who are of a different race than I am,” and others. They were asked about bullying and harassment, alcohol use, positive social norms related to violence prevention, and a combination of interpersonal strengths.

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The teens were surveyed again six months later.

The findings are part of a larger study on involving youth as leaders in order to help prevent sexual violence among middle and high school students.

Banyard partnered with the University of Nebraska Lincoln Center on Children, Youth, Families, and Schools and the University of New Hampshire.

Bullying affects many in the LGBTQIA community.

For instance, in July 2019, a study found that bullying is more prevalent in birth-assigned females and in out individuals, commonly consisting of homophobic/transphobic (particularly in socially transitioned individuals) or appearance-related (particularly in out individuals) name calling.

A November 2018 study also found that 35.2% of gay/bisexual men who had experienced frequent school-age bullying experience frequent workplace bullying. Among lesbian women, the figure was 29%.

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Health & Wellness

Access to identification documents reflecting gender identity may improve trans mental health

A study finds that possessing gender-concordant IDs is associated with reduced psychological distress, and a lower prevalence of suicidal thoughts and suicide planning.

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Photo by Cecilie Johnsen from Unsplash.com

A study finds that possessing gender-concordant IDs is associated with reduced psychological distress, and a lower prevalence of suicidal thoughts and suicide planning. And the authors suggest policy changes to increase access to gender-concordant IDs. For example, by reducing fees, administrative hurdles and eligibility requirements, and also by either expanding gender options beyond male or female, or by removing gender markers entirely.

Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The authors note that the survey only questioned respondents at one time point, making it difficult to confirm whether lack of gender-affirming IDs caused psychological distress or the other way around. It is possible that trans people suffering from psychological distress might find it harder to obtain IDs. However, a previous Canadian study found that having at least one document showing a trans person’s preferred gender marker was associated with fewer suicidal thoughts and suicide attempts, and previous research has found that mental health risks in transgender adolescents are reduced when their preferred name is used socially.

“Our results suggest that governments and administrative bodies can play an important role in helping to reduce psychological distress for trans people, simply by making it easier to access identity documents that reflect their identity,” says Dr Ayden Scheim from Drexel University, USA.

Of the 1.4 million Americans who identify as transgender, over half are estimated to have clinical depression, compared to around 30% over a lifetime in the general US population, while 31% to 41% attempt suicide at some point during their lives, compared to less than 9% generally in the US. These mental health disparities can be attributed in part to a lack of recognition and acceptance of trans people’s identified gender. Lack of gender-concordant official documents can prevent access to services such as healthcare, education, and employment, and increase exposure to verbal harassment and violence.

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The authors suggest that at the moment, the ID change process can be difficult to impossible. For example, in most US states updating a name on government-issued ID first requires a court-ordered name change, which can cost several hundred dollars. Most states require medical letters or affidavits to validate reclassification requests, and some may require gender transition surgery. In most jurisdictions, gender markers reflecting non-binary gender identity (such as an ‘X’ marker) are not yet available.

To explore the impact of access to IDs on psychological distress, suicidal thoughts and suicide attempts, researchers analysed data from 22,286 trans people, who were surveyed in 2015. Respondents were asked whether all, some or none of their IDs – including birth certificates, passports and driving licences – listed their preferred name and gender marker. Psychological distress was measured using a validated scale with a score between 0 and 24, with 13 or greater indicating serious psychological distress. To assess respondents’ suicide risk, they were asked whether they had seriously considered suicide in the previous 12 months, whether they had made any plans to kill themselves and whether they had attempted suicide.

To ensure that the analysis was able to pick up any association between mental health and access to updated IDs, the authors of the current study adjusted the results to account for other variables that could contribute to psychological distress and suicidal thoughts – such as age, ethnicity, medical transition status and years living full-time in the identified gender.

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The results found that 45.1% of respondents (10,288 out of 22,286) had no IDs with their preferred name and gender marker, 44.2% (9,666/22,286) had some ID that matched their name and/or gender, and only 10.7% (2,332/22,286) had their preferred name and gender on all their documents. The authors weighted the sample to reflect the age and ethnicity of the US population, although they note that trans demographics may not mirror broader US population demographics.

The reasons for not changing gender markers included a lack of suitable gender options (in the group with no concordant ID, people with non-binary identities were over-represented), cost, and perceived ineligibility (for example, believing that additional medical treatment was required). The authors also identified geographic variation in the results, with participants in western states more likely to have gender-concordant ID, while those in the Midwest were less likely.

Those with all gender-concordant IDs had a 32% lower prevalence of serious psychological distress than those with no updated documents. They were also 22% less likely to have had suicidal thoughts in the past year and 25% less likely to have made plans to kill themselves. Those with some updated IDs had smaller reductions in distress and suicidal thoughts (e.g., 12% reduction in distress). The results did not indicate an association between access to IDs and suicide attempts, once the authors had adjusted for other influences on mental health.

“When a trans person changes their gender on their official documents, it can be a critical step towards gaining social acceptance and legal recognition, and our findings suggest that policy changes to support trans people with taking this step should be considered, in order to help improve their wellbeing, reduce their exposure to discrimination and reduce suicidal thoughts,” says Professor Greta Bauer from Western University, Canada.

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The authors note that other variables not covered in the study may mediate psychological distress, for example access to social support.

Writing in a linked comment, lead author Dr Monica Malta (who was not involved in the study) from the University of Toronto says: “The cross-sectional study design prohibits causal interpretation of the identified relationships, and reverse causation is plausible–those with better mental health might be better able to navigate the difficult bureaucratic requirements to obtain gender congruent IDs. Even with those limitations, the large dataset and careful inclusion of potential confounders strengthen the study design. Thus, the authors’ findings support the need to increase the availability of and streamline the processes to obtain gender congruent IDs. Gaining gender-congruent IDs should be easy, affordable, and quickly completed by adequately trained officials at TGD-friendly environments.”

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