title: Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain.
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.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Kresge 7th floor, Boston, MA, 02115, USA, sreisner@hsph.harvard.edu.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.forename: Katie
authors.initials: K
authors.lastname: Biello
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Rosenberger
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.forename: Amaya
authors.initials: A
authors.lastname: Perez-Brumer
authors.forename: David S
authors.initials: DS
authors.lastname: Novak
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
mesh_terms: D000293:Adolescent; D000328:Adult; D017691:Caribbean Region; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D005783:Gender Identity; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology*; D006305:Health Status Indicators; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011174:Portugal; D012044:Regression Analysis; D060728:Reproductive Health; D012309:Risk-Taking; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D013030:Spain; D013405:Suicide; D063106:Transgender Persons / Q000523:psychology*; D014189:Transsexualism / Q000523:psychology*; D055815:Young Adult