Chenxi Liu, Jianing Zheng, Yushu Liu, Xi Wang, Yuting Zhang, Qiang Fu, Wenwen Yu, Ting Yu, Wang Jiang, Dan Wang, Chaojie Liu
{"title":"Potential to perpetuate social biases in health care by Chinese large language models: a model evaluation study.","authors":"Chenxi Liu, Jianing Zheng, Yushu Liu, Xi Wang, Yuting Zhang, Qiang Fu, Wenwen Yu, Ting Yu, Wang Jiang, Dan Wang, Chaojie Liu","doi":"10.1186/s12939-025-02581-5","DOIUrl":"10.1186/s12939-025-02581-5","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) may perpetuate or amplify social biases toward patients. We systematically assessed potential biases of three popular Chinese LLMs in clinical application scenarios.</p><p><strong>Methods: </strong>We tested whether Qwen, Erine, and Baichuan encode social biases for patients of different sex, ethnicity, educational attainment, income level, and health insurance status. First, we prompted LLMs to generate clinical cases for medical education (n = 8,289) and compared the distribution of patient characteristics in LLM-generated cases with national distributions in China. Second, New England Journal of Medicine Healer clinical vignettes were used to prompt LLMs to generate differential diagnoses and treatment plans (n = 45,600), with variations analyzed based on sociodemographic characteristics. Third, we prompted LLMs to assess patient needs (n = 51,039) based on clinical cases, revealing any implicit biases toward patients with different characteristics.</p><p><strong>Results: </strong>The three LLMs showed social biases toward patients with different characteristics to varying degrees in medical education, diagnostic and treatment recommendation, and patient needs assessment. These biases were more frequent in relation to sex, ethnicity, income level, and health insurance status, compared to educational attainment. Overall, the three LLMs failed to appropriately model the sociodemographic diversity of medical conditions, consistently over-representing male, high-education and high-income populations. They also showed a higher referral rate, indicating potential refusal to treat patients, for minority ethnic groups and those without insurance or living with low incomes. The three LLMs were more likely to recommend pain medications for males, and considered patients with higher educational attainment, Han ethnicity, higher income, and those with health insurance as having healthier relationships with others.</p><p><strong>Interpretation: </strong>Our findings broaden the scopes of potential biases inherited in LLMs and highlight the urgent need for systematic and continuous assessments of social biases in LLMs in real-world clinical applications.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"206"},"PeriodicalIF":4.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meike C M Theunissen, Monique C J Koks-Leensen, Jane van Geenen, Geraline L Leusink, Jenneken Naaldenberg, Kirsten E Bevelander
{"title":"Engaging underrepresented populations in public health monitoring: strategies for people with mild intellectual disability or low literacy skills.","authors":"Meike C M Theunissen, Monique C J Koks-Leensen, Jane van Geenen, Geraline L Leusink, Jenneken Naaldenberg, Kirsten E Bevelander","doi":"10.1186/s12939-025-02578-0","DOIUrl":"10.1186/s12939-025-02578-0","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"204"},"PeriodicalIF":4.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bridging the gap: telemedicine as a solution for HIV care inequities in rural and vulnerable communities.","authors":"Chisom Ogochukwu Ezenwaji, Esther Ugo Alum, Okechukwu Paul-Chima Ugwu","doi":"10.1186/s12939-025-02584-2","DOIUrl":"10.1186/s12939-025-02584-2","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in HIV management, healthcare inequalities continue to exist, especially in rural and populations vulnerable to HIV, where factors such as distance, low income, prejudice, and a shortage of healthcare workers contribute to delayed diagnosis and inadequate care.</p><p><strong>Objective: </strong>This commentary explores how telemedicine can close the healthcare disparity gap for HIV patients in rural and vulnerable settings by bringing care closer and decreasing stigma.</p><p><strong>Methods: </strong>The study analyzed primary sources, such as articles from PubMed, Science Direct, the Web of Science, and WHO reports from 2020 to 2024, including case studies, to examine the role of telemedicine in global HIV care. It assessed challenges, effectiveness, and infrastructural barriers, as well as policy implications.</p><p><strong>Results: </strong>Telemedicine in HIV care for rural and vulnerable groups includes virtual consultation, monitoring, telehealth, digital health education, diagnostic services, telecounselling, telemental health, telepreventive care, and emergency services. It improves treatment involvement, reduces travel, ensures confidentiality, and reduces social disapproval. However, internet inefficiency and infrastructure issues in isolated regions hinder its use.</p><p><strong>Conclusion: </strong>Telemedicine effectively addresses HIV care gaps in rural and high-risk populations by increasing service utilization, reducing stigma, and improving patient care quality; however, long-term sustainability requires infrastructure improvements and internet connectivity issues.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"205"},"PeriodicalIF":4.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sameh Mortazhejri, Isabella M Thomas, Andrea M Patey, Amjad Alghamyan, Curtis Cooper, Sarah Mansour, Smita Pakhale, Justin Presseau, Jeremy M Grimshaw, Christina Greenaway
{"title":"Perceptions about hepatitis C and barriers and enablers to screening and treatment among Egyptian immigrants to Canada: a theory-informed qualitative study.","authors":"Sameh Mortazhejri, Isabella M Thomas, Andrea M Patey, Amjad Alghamyan, Curtis Cooper, Sarah Mansour, Smita Pakhale, Justin Presseau, Jeremy M Grimshaw, Christina Greenaway","doi":"10.1186/s12939-025-02582-4","DOIUrl":"10.1186/s12939-025-02582-4","url":null,"abstract":"<p><strong>Background: </strong>Despite availability of effective screening and treatment for Hepatitis C (HCV), the uptake remains suboptimal. Immigrants from HCV endemic countries comprise 35% of cases in Canada. There is an average 10-year diagnosis delay, causing poor health outcomes and high healthcare system costs. Therefore, we aimed to understand immigrants' perceptions and beliefs about HCV, as well as the barriers and enablers to HCV care among immigrants, with a focus on individuals from Egypt, given the country's high endemic rates of HCV infection and the large Egyptian community in Canada.</p><p><strong>Methods: </strong>We established a Community Advisory Group to provide advice at all stages. We used a qualitative-descriptive design guided by the Common-Sense Self-Regulation Model and Theoretical Domains Framework to perform semi-structured interviews with adult immigrants from Egypt (with or without HCV) in Ottawa, Canada. Sampling continued until thematic saturation was achieved. The interviews were double-coded and key findings were identified.</p><p><strong>Results: </strong>We conducted interviews with 18 individuals (eight females, ten males), including 12 who had undergone HCV screening. Among them, seven had tested positive, and all had received treatment. While all participants were aware of HCV, misconceptions and a lack of knowledge regarding its symptoms, modes of transmission, and treatment options were prevalent. Many stated that they would not seek screening in the absence of significant symptoms. Perceived stigma associated with HCV and experiences of ethnocultural discrimination discouraged some individuals from seeking care. Additionally, challenges such as limited access to family doctors and long wait times were frequently cited as barriers. However, those who had received HCV treatment reported positive experiences and remained engaged in follow-up care.</p><p><strong>Conclusion: </strong>There is an urgent need to improve access to care for immigrants from endemic countries to eliminate HCV in Canada. We took a systematic, theory-informed approach to understand lived experiences and views among Egyptian immigrants in Canada. We identified key factors contributing to the low uptake of HCV screening and treatment. These findings will inform a theory-based intervention to optimize HCV care in immigrant communities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"203"},"PeriodicalIF":4.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144617369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Developing health care provider knowledge, confidence, and cultural sensitivity through resident transgender training: a controlled educational study.","authors":"Kathie Huang, Almira J Yang, Lynnetta Skoretz, Anthony Firek, Dhruv Khurana","doi":"10.1186/s12939-025-02555-7","DOIUrl":"10.1186/s12939-025-02555-7","url":null,"abstract":"<p><strong>Background: </strong>Transgender and gender-diverse (TGD) individuals face substantial health disparities as a result of discrimination and poor provider competence in understanding their health needs. Relatively little work has been done studying educational interventions targeted toward increasing residents' knowledge and ability to treat TGD individuals with sensitivity. We studied the effectiveness of implementing a lecture series on transgender health in preparing internal medicine residents to care for the TGD population.</p><p><strong>Methods: </strong>Both study and control participants were recruited through their affiliated internal medicine residency programs. The study design was a pre-post controlled educational study. A lecture series was developed at Riverside University Health System as the educational intervention. We used a Transgender Assessment survey developed for the study to determine changes in the residents' knowledge, self-confidence, and knowledge of barriers to care during the study period from January to June 2022. The data were statistically analyzed to assess the differences between pre- and post- and study and control groups.</p><p><strong>Results: </strong>Similar demographics were noted between the study and control groups. Compared with the control group, residents in the study group tended to have more exposure to transgender health education prior to the study. Residents in the study group demonstrated increased knowledge and self-confidence after completing the curriculum. The study group's average knowledge score increased from 4.8 to 6.1 post-intervention (p = 0.004). Self-confidence scores in providing gender-specific care rose from an average of 13.7 to 17.9 post-intervention (p < 0.001). The study group had higher post-intervention scores compared to the control group, particularly in knowledge of gender-affirming therapies (post 4.3 vs. pre 3.4, p = 0.01) and self-confidence in providing gender-specific care (post 17.9 vs. pre 12.3, p=0.004). No significant changes were observed in knowledge of barriers to care for both groups.</p><p><strong>Conclusions: </strong>Our study demonstrates the effectiveness of a curriculum focused on TGD health in improving residents' knowledge and confidence. Further research is needed on the durability of these effects and the curriculum's impact on awareness of barriers to care. Implementing such curricula at other institutions could reinforce educational programs in medical schools to improve provider competence and address the healthcare needs of TGD individuals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"202"},"PeriodicalIF":4.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claudio Vargas, Paola Salas, Felipe Elorrieta, Valentina Muñoz, Erika Vivanco, Matilde Maddaleno
{"title":"Inequities in mortality and potential years of life lost (PYLL) in greater Santiago, Chile, during and after the COVID-19 pandemic.","authors":"Claudio Vargas, Paola Salas, Felipe Elorrieta, Valentina Muñoz, Erika Vivanco, Matilde Maddaleno","doi":"10.1186/s12939-025-02575-3","DOIUrl":"10.1186/s12939-025-02575-3","url":null,"abstract":"<p><strong>Introduction: </strong>In Chile and worldwide, disparities in age-adjusted mortality rates and Potential Years of Life Lost (PYLL) intensified during the initial two years of the COVID-19 pandemic, with low- and middle-income countries experiencing a disproportionate burden. However, the post-pandemic landscape in Chile has yet to be comprehensively characterized.</p><p><strong>Objective: </strong>To evaluate the evolution of inequities in mortality rates and PYLL during the post-pandemic years (2022 and 2023) in Greater Santiago, comparing these with pandemic years (2020 and 2021) and the pre-pandemic period (2002-2019).</p><p><strong>Methods: </strong>This study uses publicly available data from the 34 urban municipalities of the Greater Santiago Metropolitan Region provided by the Department of Statistics and Health Information (DEIS) of the Chilean Ministry of Health. Inequality indices, such as the Concentration Index (CI) and the Relative Index of Inequality (RII), were estimated using the average per capita income of each municipality as the ranking variable.</p><p><strong>Results: </strong>Age-adjusted mortality rates and PYLL have re-established their pre-pandemic declining trajectory, although at different magnitudes. Concurrently, levels of inequity, although reduced from the peaks observed during the pandemic, have reverted to their prior upward trend. During the pandemic, between 2019 and 2020, mortality and PYLL increased by 31% and 32%, respectively, in the lowest-income municipalities, reaching levels comparable to those observed in 2002. In contrast, wealthier municipalities experienced substantially smaller impacts. These patterns were consistently observed across multiple inequality assessment methodologies, including municipal income quintile comparisons, the Concentration Index (CI), and the Relative Index of Inequality (RII).</p><p><strong>Conclusions: </strong>In Greater Santiago, although mortality rates and PYLL in 2023 declined below pre-pandemic levels, health inequities exhibited only a temporary decline. Subsequently, these disparities have resumed the upward trajectory characteristic of the pre-pandemic period.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"201"},"PeriodicalIF":4.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lupita Ana Maria Valladolid-Sandoval, Luisa Erika Milagros Vásquez-Romero, Joan A Loayza-Castro, Nataly Mayely Sanchez-Tamay, Angie Chuquimbalqui Coronel, Fiorella E Zuzunaga-Montoya, Carmen Inés Gutierrez De Carrillo, Víctor Juan Vera-Ponce
{"title":"Trends and disparities in the coexistence of anemia and obesity among Peruvian women aged 20-49 years: doubling prevalence in two decades of National surveillance.","authors":"Lupita Ana Maria Valladolid-Sandoval, Luisa Erika Milagros Vásquez-Romero, Joan A Loayza-Castro, Nataly Mayely Sanchez-Tamay, Angie Chuquimbalqui Coronel, Fiorella E Zuzunaga-Montoya, Carmen Inés Gutierrez De Carrillo, Víctor Juan Vera-Ponce","doi":"10.1186/s12939-025-02576-2","DOIUrl":"10.1186/s12939-025-02576-2","url":null,"abstract":"<p><strong>Introduction: </strong>The coexistence of anemia and obesity represents a growing challenge in countries experiencing accelerated nutritional transitions. The marked geographic and socioeconomic heterogeneity in Peru provides a unique context for exploring their joint occurrence disparities.</p><p><strong>Objectives: </strong>To determine temporal trends, geographic distribution, and sociodemographic disparities associated with the coexistence of anemia and obesity in women aged 20-49, using data from the Demographic and Family Health Survey (DHS).</p><p><strong>Methodology: </strong>A cross-sectional study with analytical and geospatial approaches was conducted using DHS data from 2005 to 2023. The main variable combined anemia (hemoglobin < 12 g/dL in non-pregnant women) and obesity (BMI ≥ 30 kg/m²) into four categories. Descriptive analyses, bivariate analyses, and polytomous logistic regressions adjusted for age and sex were performed. Additionally, geospatial distribution was explored through prevalence mapping and Moran's Index calculation.</p><p><strong>Results: </strong>In a sample of 326 474 women evaluated during the 2005-2023 period, the coexistence of anemia and obesity more than doubled (from 3.45% in 2005 to 7.43% in 2023). Concurrently, obesity without anemia more than doubled (from 11.20 to 23.84%, peaking at 28.71% in 2021), while the proportion of women without either condition decreased substantially from 58.57 to 50.12%. Multivariate analysis revealed higher odds of this dual condition in middle and high socioeconomic levels, while urban residence, higher education, and highland residence were associated with lower probability.</p><p><strong>Conclusions: </strong>The joint occurrence of anemia and obesity constitutes a growing priority problem, as demonstrated by its prevalence of more than doubling over the past 19 years, in a context where obesity without anemia also more than doubled, and the proportion of healthy women decreased considerably. This phenomenon requires urgent multisectoral interventions to address micronutrient deficiency and overweight/obesity, emphasizing the identified regional and sociodemographic disparities.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"200"},"PeriodicalIF":4.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zoheb Khan, Frederico Haddad, Vinodkumar Rao, Jith J R, Parvathy Breeze, Surekha Garimella, Leslie London
{"title":"Community participation and contracting between state and non-state actors in primary care: A scoping review of evidence.","authors":"Zoheb Khan, Frederico Haddad, Vinodkumar Rao, Jith J R, Parvathy Breeze, Surekha Garimella, Leslie London","doi":"10.1186/s12939-025-02567-3","DOIUrl":"10.1186/s12939-025-02567-3","url":null,"abstract":"<p><strong>Background: </strong>Health systems worldwide increasingly involve non-state actors in governance and service provision, often to address perceived limitations in public sector capacity to achieve or maintain universal health coverage. Contracts are a key mechanism for structuring such cooperation, enabling governments to define public priorities, specify the resources and services required to achieve them, establish performance requirements for contractors, and define accountability mechanisms. Moreover, community participation in the design and monitoring-or governance-of contracts could enhance the effectiveness of contracting by making services more locally responsive and accountable. This article reviews the global evidence on contracting out-with and without community participation-and its effects on access to primary care services, the quality of these services, and equity in health.</p><p><strong>Methods: </strong>A scoping review was undertaken following the PRISMA checklist for evidence synthesis. A common search string was applied to five databases - SciELO, LILACS, EBSCOhost, Scopus, and Google Scholar - to search for articles relating to our research questions in English, Spanish and Portuguese, with no restrictions on publication date. After three rounds of review, 81 articles were selected from a universe of 3,276 articles and subjected to full data analysis. These were complemented by 14 handpicked articles meeting our study criteria and 26 supplementary references.</p><p><strong>Results: </strong>We find that community participation in the governance of contracting is rare, but can promote access and quality. However, it requires a contracting environment that supports transparency, cooperation from governments and providers, and resourcing commitments. More generally, contracting is often associated with access gains, but the evidence on quality and equity is mixed.</p><p><strong>Conclusions: </strong>Contracting of non-state providers in pluralistic primary care systems that incorporates the participation of communities in its governance could be a feasible policy to promote universal health coverage while also effecting democratic rights of citizens to participate in healthcare governance. Primary research is required to better understand how to promote meaningful community participation, and to identify the contractual details and features of specific contractual environments that are connected to better outcomes.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"199"},"PeriodicalIF":4.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Moreno-García, Paule González-Recio, Marta Donat, Carlos Iniesta, Cinta Folch, María Alonso-Colón, Juan Miguel Guerras, María José Belza
{"title":"Inequities in HIV prevention among trans and/or non-binary people: a cross-sectional survey analysis of PrEP and PEP awareness and use in Spain.","authors":"Sara Moreno-García, Paule González-Recio, Marta Donat, Carlos Iniesta, Cinta Folch, María Alonso-Colón, Juan Miguel Guerras, María José Belza","doi":"10.1186/s12939-025-02574-4","DOIUrl":"10.1186/s12939-025-02574-4","url":null,"abstract":"<p><strong>Background: </strong>HIV continues to be a global public health challenge, especially in transgender and non-binary people (TGNB). Despite the high effectiveness of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) in reducing HIV transmission, their implementation in this population is unknown. This study describes PrEP and PEP awareness, knowledge of how to access, and use and identifies the factors associated among the TGNB population living in Spain.</p><p><strong>Methods: </strong>Data from 1468 participants in Transaludes, a national online survey aimed at TGNB people living in Spain, were analysed. The prevalence of awareness, knowledge of how to access both PrEP and PEP through the public healthcare system, and use of each strategy were estimated. Factors associated with awareness and use were analysed using Poisson regressions with robust variance.</p><p><strong>Results: </strong>A total of 50.5% were aware of PrEP, 14.7% knew how to access PrEP, 2.8% had used it and 1.6% currently, mostly on a daily regimen. A total of 32.5% were aware of PEP, only 13.2% knew how to access PEP and 1.6% had used it, mostly once. Awareness of both strategies was associated with being a non-binary person assigned male at birth (AMAB) or trans woman, being foreign, having a university degree, having undergone biomedical transition and in the past year, having condomless sex with one partner and having engaged in sex work. Use was associated with being older, living in large cities, and in the past year, having condomless sex with two or more partners, having engaged in sex work, and having an STI diagnosis.</p><p><strong>Conclusions: </strong>Awareness of PrEP is moderate, while that of PEP is lower; in both cases, there is a high lack of knowledge about how to access them, and use of both strategies is low. Disparities, particularly among certain subgroups, such as trans men, younger TGNB, those with low educational level and those living in smaller cities, reflect structural inequities in access to both strategies. Targeted and tailored strategies, including campaigns to improve awareness and access to these prevention tools are needed to reduce these gaps within TGNB populations and achieve the goals for ending the HIV epidemic.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"197"},"PeriodicalIF":4.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Romina Caballero, Estefania Panizoni, Raúl Mejía, Ana Zeltman, Nadir Fernanda Cardozo, Alixida Ramos-Pibernus, Ash B Alpert, Ana Paula Cupertino, Francisco Cartujano-Barrera, Ines Aristegui
{"title":"Understanding biopsychosocial factors influencing cigarette smoking among transgender and gender diverse individuals living in Argentina: a qualitative study.","authors":"Romina Caballero, Estefania Panizoni, Raúl Mejía, Ana Zeltman, Nadir Fernanda Cardozo, Alixida Ramos-Pibernus, Ash B Alpert, Ana Paula Cupertino, Francisco Cartujano-Barrera, Ines Aristegui","doi":"10.1186/s12939-025-02563-7","DOIUrl":"10.1186/s12939-025-02563-7","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"196"},"PeriodicalIF":4.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}