"I Needed to be That Voice": A Multi-Party Study of the Healthcare and Social Service Experiences and Needs of Transgender and Gender-diverse Older Adults in Canada.

The social contexts of transgender and gender-diverse (TGD) older adults remain under-examined. In this qualitative study, which involved six virtual focus groups with a total of 21 participants inclusive of TGD adults ages 50+, service providers, and community advocates, we sought to examine the healthcare and social service experiences and needs of TGD older adults in Canada. Drawing theoretically on critical gerontology and intersectionality, and methodologically on interpretive description, we examined the perspectives of different participant groups to develop insight into TGD older adults' issues and priorities in the context of their engagements with systems of care.

2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study.

Background: Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.

Methods: This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness.

Achieving 2S/LGBTQ+ Health Equity Requires Grappling With the Structural Drivers of Poor Health in Sexual and Gender Minorities.

While the need for research, policy and practice addressing the health equity issues of Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations is increasingly recognized, we acknowledge that significant gaps remain in this area. As authors in this themed issue have consistently pointed out, interventions that grapple with the intersectionally varied structural drivers of 2S/LGBTQ+ health remain lacking and, in particular, warrant urgent consideration. This is especially the case during a time when structural threats to the well-being of 2S/LGBTQ+ populations are on the rise, both in Canada and in other geopolitical contexts.

Beyond the Rainbow: Advancing 2S/LGBTQ+ Health Equity at a Time of Political Volatility.

Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations continue to experience profound health disparities. In this article, we prioritize five issues in 2S/LGBTQ+ health equity and discuss policy interventions to address disparities in each area: (1) poverty in 2S/LGBTQ+ communities; (2) Two-Spirit mental health; (3) health equity issues in migrant and racialized LGBTQ+ populations; (4) challenges in implementing bans on conversion therapy; and (5) the evolving context of gender-affirming care. Multi-level policy interventions, including those in healthcare-adjacent contexts such as housing and immigration, will be critical to address the structural undercurrents driving health inequities for 2S/LGBTQ+ populations.

Homes of substance: Drugs and the making of home/lessness for 2S/LGBTQ+ youth.

Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual minority (2S/LGBTQ+) youth between the ages of 14 and 29 experience inequities in homelessness and substance use. Research in this area has explored substance use as a determinant of homelessness and/or as a coping mechanism, yet far less attention has been directed to the potentially generative role of drugs in this marginalizing context. This community-based photovoice study leverages data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth experiencing homelessness and unstable housing to examine how drugs shape their practices and contexts of homemaking.

"To smoke feels gender": Exploring the transformative and emancipatory capacities of cannabis among transgender, non-binary and gender non-conforming (TGNC) youth.

Background: Transgender, non-binary and gender non-conforming (herein, "TGNC") youth (15-24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to mental health inequities.

"You kind of blame it on the alcohol, but. . .": A discourse analysis of alcohol use and sexual consent among young men in Vancouver, Canada.

There is growing awareness about issues of sexual consent, especially in autonomy-compromising or "non-ideal" contexts, including sex involving alcohol. Understanding the conditions needed for consensual sex to occur in this emergent milieu is critically important, especially for young men (ages 18-30 years) who normatively combine drinking alcohol with sex and are most often perpetrators of sexual violence. This study offers a discourse analysis of young men's alcohol use and sexual consent.

Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada.

Background: Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice.

Aims: To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition).

"Nowhere else to be found": Drawing on peer support experiences among transgender and gender-diverse people to substantiate community-driven gender-affirming care.

Increasingly, applied social scientists and clinicians recognize the value of engaging transgender and gender-diverse (TGD) people, particularly TGD individuals with lived experience as care recipients (peers), to inform the provision of gender-affirming care. Despite this trend, few researchers have systematically examined how this group can contribute to and enhance the development and delivery of interventions intended to affirm gender diversity. In this article, we address limitations in the literature by drawing on a secondary analysis of qualitative data - originally collected to examine the peer support experiences of TGD individuals - to explore the potential that TGD peers hold for elevating gender-affirming care.

A systematic review of the prevalence of lifetime experience with 'conversion' practices among sexual and gender minority populations.

Rationale: Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action.

Oestradiol concentrations in trans women with HIV suppressed on unboosted integrase inhibitor regimens versus trans women without HIV taking oral oestradiol: a pilot study.

Background: Feminizing hormone therapy (FHT) is essential to many trans women. Concern about negative drug interactions between FHT and ART can be an ART adherence barrier among trans women with HIV.

Objectives: In this single-centre, parallel group, cross-sectional pilot study, we measured serum oestradiol concentrations in trans women with HIV taking FHT and unboosted integrase strand transfer inhibitor (INSTI)-based ART versus trans women without HIV taking FHT.

Examining the Influence of Pre-HAART Experiences on Older, Self-Identifying Gay Men's Contemporary Constructions of Quality of Life (QOL).

Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma-the pre-HAART era of the HIV/AIDS epidemic-characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART.

Between two pandemics: Older, gay men's experiences across HIV/AIDS and COVID-19.

Pandemics are a component of human life, and have had great bearing on the trajectory of human evolution. Historically, the biomedical aspects of pandemics have been overrepresented, but there is growing recognition of the degree to which pandemics are socially and culturally embedded, highlighting how virus perception is socially and politically informed. Older (50+), gay men represent a population who have experienced two global pandemics in their lifespans: HIV/AIDS and COVID-19.

Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments.

Importance: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.

Objective: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.

Impacts of COVID-19 on trans and non-binary people in Canada: a qualitative analysis of responses to a national survey.

Background: Emerging international evidence indicates the COVID-19 pandemic has exacerbated socioeconomic and health challenges faced by transgender (trans) and non-binary populations globally. This qualitative study is among the first to characterize impacts of the pandemic on these groups in Canada.

Methods: Drawing on data from the Trans PULSE Canada survey (N = 820), we used thematic analysis to examine the free-form responses of 697 participants to one open-ended question on impacts of the pandemic.

Examining TikTok's Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups.

Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible.

"You Could Tell I Said the Wrong Things": Constructions of Sexual Identity Among Older Gay Men in Healthcare Settings.

Older gay men commonly conceal their sexual identity in healthcare settings due to past experiences and expectations of encountering stigma and discrimination in these contexts. Although insights on how older gay men construct their sexual identity in healthcare may help contextualize this phenomenon, this question remains under-explored. Accordingly, we present the findings of a secondary grounded theory analysis of individual interview data, which we originally collected to examine the healthcare experiences of 27 gay men ages 50 and over, to explore constructions of sexual identity among the group.

Implementation and evaluation of the 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)' provider education pilot.

Background: Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'.

Poverty in Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit, and Other Sexual and Gender Minority (LGBTQ2S+) Communities in Canada: Implications for Social Work Practice.

In this article, we draw on a recent review of the Canadian literature on poverty in lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender minority (LGBTQ2S+) communities to conceptualize social work interventions that may be used to address material inequities among these groups. Our literature review, which was based on a total of 39 works, revealed distinctive expressions of poverty among younger and older LGBTQ2S+ groups, as well as racialized, newcomer, and Indigenous sexual and gender minorities. Drawing on these insights, together with theoretical frameworks grounded in intersectionality and relational poverty analysis, we conceptualize these expressions of material inequity as salient sites of social work practice and propose interventions targeting these manifestations of LGBTQ2S+ poverty at various levels.