Advances in Psychiatry

NewYork-Presbyterian/Columbia has a long history of studying issues facing lesbian, gay, bisexual, transgender, and queer people in New York. The Program for the Study of LGBTQ+ Health, a program of Columbia Psychiatry in collaboration with the Columbia School of Nursing, was the first comprehensive program in New York City that championed scholarship in LGBTQ+ health beyond HIV.

Founded in 2012, the Program for the Study of LGBTQ+ Health combines research, clinical service, education and training, and innovative policy development to promote the health and well-being of LGBTQ+ youth, adults, their families, and communities. The program has five research priority areas: youth and families, trans and nonbinary health, sexual minority women’s health, LGBTQ+ aging, and neuroscience of gender.

Dr. Walter Bockting

Last year, Walter Bockting, PhD, LP, a clinical psychologist and the program’s director, recruited Jae Sevelius, PhD, a clinical psychologist, to NewYork-Presbyterian/Columbia to advance the program’s research on trans and nonbinary health. According to Dr. Sevelius, transgender identity was often pathologized in the mental health field. “I was really intrigued and disturbed by the fact that people could be diagnosed with a mental health issue or a mental disorder for having interests outside of their prescribed gender role,” they say. “The more I investigated it and the more I learned about trans identities, the more I realized how this stigma drives the health disparities that we see among trans people. I just felt so passionate about it that I wanted to dedicate my career to it.”

NewYork-Presbyterian/Columbia has conducted research looking at trans health disparities dating back to 2012. “Today, gender-affirming care emphasizes medical interventions, such as hormones and surgery, which certainly are important, yet gender-affirming mental health care is not receiving the attention it deserves, both in research and care,” says Dr. Bockting. “Our research focus today includes minority stress, mental health, and resilience, but also the impact of minority stress and gender affirming care on behavioral risk for cardiovascular disease.”

Trans women of color experience intersectional stigma that results in unmet gender affirmation needs, which have been linked to disparities in HIV prevention and continua outcomes. “Trans and gender expansive people are often socially marginalized for not conforming to rigid expectations of gender identity and expression,” Dr. Sevelius says. “Due to stigma and discrimination along with other social determinants of health, trans communities experience high rates of trauma and health disparities; this is compounded even further for trans and gender diverse people of color.”

“Due to stigma and discrimination along with other social determinants of health, trans communities experience high rates of trauma and health disparities; this is compounded even further for trans and gender diverse people of color.” – Dr. Jae Sevelius

Developing Community-Based Interventions for Trans Women of Color

Dr. Sevelius recently received a $6 million grant from the National Institute of Mental Health (NIMH) to improve HIV prevention and care for transgender women of color.

“Dr. Sevelius has years of in-depth experience working with transgender women of color communities across the country and internationally,” says Dr. Bockting. “We hope to learn what their needs are and how we can effectively address the negative impact of the chronic stigma and minority stress they experience on their health and wellbeing. Dr. Sevelius’ interventions have already shown that, with the proper holistic affirmation, transgender women of color will thrive and reach their full potential.”

“Dr. Sevelius’ interventions have already shown that, with the proper holistic affirmation, transgender women of color will thrive and reach their full potential.” – Dr. Walter Bockting

With the NIMH grant, Dr. Sevelius, along with their multi-principal investigator Kristi Gamarel, PhD at the University of Michigan, will develop community-based and peer-led interventions that address the specific needs and health disparities of transgender women of color, with an emphasis on their mental health and well-being. This new program, named Let’s Be, will take place at two different community-based clinics, one in New York (Callen Lorde) and one in Detroit (Corktown Health Center). Let’s Be will be based on Healthy Divas and Sheroes, two programs Dr. Sevelius developed while at the University of California, San Francisco. “For this project, I am taking two interventions that have proved efficacy in different contexts and creating Let’s Be, a multi-level, peer-led, trauma-informed intervention for trans women of color,” they say. “Let’s Be is an HIV status-neutral intervention designed to mitigate adverse health sequelae of stigma thereby reducing sexual risk behaviors, increasing HIV prevention uptake (PrEP use), and treatment outcomes (viral load suppression).”

Dr. Jae Sevelius

Let’s Be will involve both group- and individual-level interventions. “The group-level intervention is usually about six to eight trans women of color who come together in a series of weekly or biweekly groups for five sessions,” Dr. Sevelius says. “It’s led by two peer facilitators who are also trans women of color. Each group has a theme [that leads to] giving people accurate information about their sexual health. There’s a lot of facilitation discussion among the group to make it come alive with people’s actual experiences and help people get support from the group.”

After the group component concludes, the study participants will be assigned to a peer health educator to work on identifying and working toward achieving a health-related goal. “[The goal] can be anything from wanting to find out more about options for PrEP, to wanting to start taking hormones, or getting connected to a different doctor because their current one is very stigmatizing,” Dr. Sevelius says. “The peer educators will help the person reach their goals; along the way, they’re also being educated about how to set achievable goals, how to follow through on goals, and how to keep going when you’re frustrated and not reaching your goals.”

In addition to testing the efficacy of Let’s Be to improve health outcomes, Dr. Sevelius seeks to learn from the sites about the implementation of the intervention and whether it can successfully incorporate telehealth options. Success will be measured by PrEP adherence and viral load suppression. Additionally, Dr. Sevelius says positive participant experiences and clinic feasibility will also be factored into program success.

“I think the way that we'll measure success is through the stories of the participants, what the impact on their lives has been, and if this was a meaningful experience for them,” they say. “We will also assess if this is a feasible thing for the clinics to implement and whether it is beneficial to both the community and the clinic environment. Longer term, we would love to see this become of one of those evidence-based interventions that community-based organizations can get funding to implement and see disseminated across the country.”