Publications
List of publications
The 2018 Australian Trans and Gender Diverse Sexual Health Survey: Report of Findings (2019)
As the private lives of trans people are dragged into public debate, it’s time for facts (2019)
More detail about some of the study’s primarily publications can be found below.
Final Report
In September 2019, the final report of the Australian Trans & Gender Diverse Sexual Health Survey was launched at the joint Australasian HIV & AIDS Conference and the Australasian Sexual Health Conference in Perth, Western Australia.
The report contains details of the breadth of data collected through the survey, with nearly all variable stratified by the gender of participants. A full copy can be downloaded here. The report also contains a detailed list of recommendations arising from the survey’s findings, which were developed through a collaborative panel of trans, gender diverse, and cisgender experts and stakeholders from the fields of epidemiology, social science, community advocacy and activism, clinical care, health promotion, policy, and journalism. This panel was hosted in February 2019, the outcomes of which have and are informing subsequent analyses and the overall dissemination of findings.
A summary of the key findings and recommendations from the report can be found here.
Categorizing gender
A key recommendation from the panel of experts and stakeholders hosted in February 2019 was the need for an evidence-based approach to understanding and categorizing the genders of those who participated in the Australian Trans & Gender Diverse Sexual Health Survey. In addition to the fixed gender options with which participants were presented, hundreds of additional and unique gender labels were provided by those who took part in the survey. While preliminary analyses made clear that gender was an important factor in understanding differences in experiences, perceptions and outcomes related to sexual health and well-being, before researchers could make sense of these differences a system for categorizing gender was clearly needed.
In early 2020, researchers employed a mixed methods approach to better understand the ways in which gender was labeled and experienced by survey participants. This involved reviewing the written responses provided by participants and re-coding them into existing categories or, as needed, creating new ones. Because the majority (71%) of participants selected two or more labels with which to describe their gender, a form of analysis known as ‘algorithm-based hierarchical clustering’ was undertaken, which involved examining if certain gender labels were more or less likely to be grouped together. This approach allowed researchers to generate broad ‘gender clusters’ that could be used to group different kinds of genders into similar categories. Two broad clusters were identified: (i) binary (e.g., trans man, man, trans woman, women) and (ii) non-binary (e.g. genderqueer, agender, trans masculine). Additionally, clusters could be stratified by gender presumed at birth, namely: (i) trans man/man, (ii) trans woman/woman, (iii) non-binary, presumed male at birth, and (iv) non-binary, presumed female at birth.
The methods, findings and interpretations of these analyses have been published in the journal Transgender Health. This system of categorization provides one way that systems of health care and research can be adapted to be more inclusive of gender diversity, although it is noted that such categorization should never be applied at the expense of individuals. Further, categorizing gender in the context of health and research must remain a flexible and iterative process, which is amenable to change and adaption as understandings of gender continue to evolve and expand.
Cisgenderism and transphobia in sexual health care
Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of ‘gender insensitivity’, which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation.
Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4; p<0.001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p<0.001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,-0.03, p = 0.007).
Given the high rates of HIV and other STIs among trans and gender diverse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.