Publications by authors named "Sel Hwahng"

15 Publications

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Alternative kinship structures, resilience and social support among immigrant trans Latinas in the USA.

Cult Health Sex 2019 01 16;21(1):1-15. Epub 2018 Apr 16.

a Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA.

Latinas comprise the largest racial/ethnic group of trans women (male-to-female transgender people) in New York City, where HIV seroprevalence among trans Latinas has been found to be as high as 49%. Despite this population's high risk of HIV, little is known about resilience among trans Latinas that may provide protective health factors. Six focus groups and one in-depth interview were conducted with 34 low-income trans/gender-variant people of colour who attended transgender support groups at harm reduction programmes in New York City. This paper reports on data from 13 participants who identified as immigrant trans Latinas. Focus groups were coded and analysed using thematic qualitative methods. The majority of immigrants were undocumented but reported having robust social support. Unique characteristics of immigrant trans Latinas included alternative kinship structures and sources of income. Social creativity was used to develop achievable ways in which to improve their health outcomes. Resilience was evident in informal kinship dynamics, formal support groups, gender-transition, educational access and skills training and substance use reduction. Individual-level resilience increased as a result of strong community-level resilience.
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http://dx.doi.org/10.1080/13691058.2018.1440323DOI Listing
January 2019

Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study.

AIDS Behav 2017 Dec;21(12):3328-3335

National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA.

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.
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http://dx.doi.org/10.1007/s10461-016-1509-4DOI Listing
December 2017

Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study.

AIDS Behav 2017 Dec;21(12):3328-3335

National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA.

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.
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http://dx.doi.org/10.1007/s10461-016-1509-4DOI Listing
December 2017

Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study.

Am J Public Health 2014 Nov 11;104(11):2199-206. Epub 2014 Sep 11.

At the time of this research, Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute/Columbia University, New York, NY. Larry Nuttbrock, Andrew Rosenblum, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Sel Hwahng is with Columbia University.

Objectives: We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women.

Methods: We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links.

Results: Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse.

Conclusions: Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population.
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http://dx.doi.org/10.2105/AJPH.2014.302106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202966PMC
November 2014

Gender abuse and major depression among transgender women: a prospective study of vulnerability and resilience.

Am J Public Health 2014 Nov 12;104(11):2191-8. Epub 2013 Dec 12.

At the time of this research, Larry Nuttbrock, Andrew Rosenblum, Sel Hwahng, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute, Columbia University, New York, NY.

Objectives: We examined the social and interpersonal context of gender abuse and its effects on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depression among transgender women.

Methods: We conducted a 3-year prospective study (2004-2007) among 230 transgender women aged 19 to 59 years from the New York City Metropolitan Area. Statistical techniques included generalized estimating equations (logistic regression).

Results: We observed significant associations of psychological and physical gender abuse with major depression during follow-up. New or persistent experiences of both types of abuse were associated with 4- to 7-fold increases in the likelihood of incident major depression. Employment, transgender presentation, sex work, and hormone therapy correlated across time with psychological abuse; the latter 2 variables correlated with physical abuse. The association of psychological abuse with depression was stronger among younger than among older transgender women.

Conclusions: Psychological and physical gender abuse is endemic in this population and may result from occupational success and attempts to affirm gender identity. Both types of abuse have serious mental health consequences in the form of major depression. Older transgender women have apparently developed some degree of resilience to psychological gender abuse.
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http://dx.doi.org/10.2105/AJPH.2013.301545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202964PMC
November 2014

Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City.

J Homosex 2014 ;61(5):691-713

a Columbia University/Beth Israel Medical Center , New York , New York , USA.

Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.
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http://dx.doi.org/10.1080/00918369.2014.870439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711521PMC
December 2014

Female-to-male transmasculine adult health: a mixed-methods community-based needs assessment.

J Am Psychiatr Nurses Assoc 2013 Sep-Oct;19(5):293-303. Epub 2013 Aug 20.

Sari L. Reisner, ScD, MA, Harvard School of Public Health, Boston, MA; Fenway Health, Boston, MA, USA.

Background: There is a dearth of health research about transgender people.

Objectives: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults.

Design: A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues.

Results: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors.

Conclusions: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.
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http://dx.doi.org/10.1177/1078390313500693DOI Listing
June 2014

Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study.

Am J Public Health 2013 Feb 14;103(2):300-7. Epub 2012 Jun 14.

National Development and Research Institutes, New York, NY, USA.

Objectives: We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs).

Methods: We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the New York Metropolitan Area. Statistical techniques included Cox proportional hazards analysis with time varying covariates.

Results: Among younger MTFs (aged 19-30 years), gender abuse predicted depressive symptoms (Center for Epidemiologic Studies Depression score ≥ 20), and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior (unprotected receptive anal intercourse) and incident HIV/STI. These associations were independent of socioeconomic status, ethnicity, sexual orientation, hormone therapy, and sexual reassignment surgery.

Conclusions: Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs. Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior. Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse.
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http://dx.doi.org/10.2105/AJPH.2011.300568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558792PMC
February 2013

HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City.

Subst Use Misuse 2011 ;46(2-3):274-84

Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029-5283, USA.

Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWs have been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.
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http://dx.doi.org/10.3109/10826084.2011.523284DOI Listing
July 2011

A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria.

Arch Sex Behav 2011 Apr 29;40(2):247-57. Epub 2009 Dec 29.

National Development and Research Institutes, 71 West 23rd Street, New York, NY 10010, USA.

In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.
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http://dx.doi.org/10.1007/s10508-009-9579-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894986PMC
April 2011

Vaccination, quarantine, and hygiene: Korean sex slaves and No. 606 injections during the Pacific War of World War II.

Authors:
Sel J Hwahng

Subst Use Misuse 2009 ;44(12):1768-802

National Development and Research Institutes, Inc., New York City, New York 10010, USA.

Unlabelled: During the Pacific War (World War II), Japan maintained an elaborate system of sexual slavery by implementing certain practices based on institutionalized policies of hygiene, efficiency, and the use of mostly Korean girls and women. Two hygienic techniques were established--vaccination and quarantine. No. 606 injections were given at mandatory regularly scheduled medical examinations to prevent and treat venereal disease, and to also deter pregnancy, induce abortions, and ultimately sterilize sex slaves.

Methods: Secondary textual analysis of data collected from 1995-2000, N = 67 interview transcripts, and participant observation in 2003 and 2006. Geographic area: East Asia and the Pacific Islands.
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http://dx.doi.org/10.3109/10826080902963480DOI Listing
January 2010

Vaccination, quarantine, and hygiene: Korean sex slaves and No. 606 injections during the Pacific War of World War II.

Authors:
Sel J Hwahng

Subst Use Misuse 2009 ;44(12):1768-802

National Development and Research Institutes, Inc., New York City, New York 10010, USA.

Unlabelled: During the Pacific War (World War II), Japan maintained an elaborate system of sexual slavery by implementing certain practices based on institutionalized policies of hygiene, efficiency, and the use of mostly Korean girls and women. Two hygienic techniques were established--vaccination and quarantine. No. 606 injections were given at mandatory regularly scheduled medical examinations to prevent and treat venereal disease, and to also deter pregnancy, induce abortions, and ultimately sterilize sex slaves.

Methods: Secondary textual analysis of data collected from 1995-2000, N = 67 interview transcripts, and participant observation in 2003 and 2006. Geographic area: East Asia and the Pacific Islands.
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http://dx.doi.org/10.3109/10826080902963480DOI Listing
January 2010

Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons.

J Acquir Immune Defic Syndr 2009 Nov;52(3):417-21

National Development and Research Institutes, New York, NY 10010, USA.

Objectives: To describe and evaluate risk factors for HIV/sexually transmitted infections (STIs) among male-to-female (MTF) transgender persons.

Methods: Using the life chart interview, potential lifetime risk factors for HIV/STIs among MTFs were measured and evaluated in conjunction with lifetime exposures for HIV, syphilis, hepatitis B, and hepatitis C. The participants were 517 MTFs between the ages of 19 and 59 years from the New York metropolitan area.

Results: HIV/STIs were low among white Americans and very high among Hispanics and African Americans. In the latter groups, HIV and hepatitis B were associated with an androphilic sexual orientation, lifetime number of commercial sex partners (sex work), and the social expression of transgender identity; syphilis was associated with lifetime number of casual sex partners; and hepatitis C was associated with injection drug use, unemployment, and social expression of transgender identity. In multivariate models, the social expression of transgender identity was the strongest and most consistent predictor of HIV/STIs. Consistent with their lower levels of infections, white Americans reported significantly lower levels of the risk factors found to be predictive of HIV/STI among Hispanics and African Americans.

Conclusions: HIV/STI prevention in this population should be targeted at Hispanic and African Americans. Prevention programs should incorporate multiple components designed to address the diverse issues confronting ethnic minority transgender persons, with an emphasis on the social expression of transgender identity.
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http://dx.doi.org/10.1097/QAI.0b013e3181ab6ed8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784264PMC
November 2009

Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City.

Sex Res Social Policy 2007 Dec;4(4):36-59

This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.
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http://dx.doi.org/10.1525/srsp.2007.4.4.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597809PMC
December 2007