Nominated From: University of Washington
Research Site: Thailand
Research Area: Psychiatry
Primary Mentor: Michelle Andrasik
Mental Health Screening in HIV positive Transgender Persons in Bangkok, Thailand
Transgender persons in Thailand with HIV are at high risk for PTSD and depression, in a country where outpatient mental health services are largely unavailable. Overall HIV prevalence in three major cities in Thailand was 13.5% according to a study in 2005 (1), and concurrent mental illnesses that may subvert prognoses of HIV positive TG persons. Mental illness has several negative impacts on the HIV positive transgender community. First, it has been shown that poorly controlled depression correlates with worse HIV medication compliance (2,5). Second, it has been shown that depressed transgender patients are more likely to engage in risky sexual behaviors (3). Third, worldwide, transgender patients are at higher risk than the general community for committing suicide (4). Unfortunately, outpatient mental health services in Thailand are not readily available and research on prevalence of PTSD and depression among HIV positive transgender patients in Thailand is lacking. A State of the art clinic, The Tangerine Clinic that provides care for transgender HIV positive patients run by the Thai Red Cross has expressed interest in developing mental health screening and services. Basic understanding of trauma exposures and predisposing experiences within this marginalized population may help unlock ways for clinicians to support, counsel, and prevent future traumas while helping to mend traumas that have already occurred. If we understand what traumas are predisposing HIV positive transgender patients towards PTSD or depression, we may be able to triage high risk patients for more intensive mental health intervention and theoretically help increase compliance with HIV treatment.
The Tangerine Clinic is a Thai Red Cross sponsored clinic for HIV positive Transgender patients in Bangkok, Thailand that provides HIV medications and transgender health services. The goal of this clinic is to alleviate the burden of HIV on this community and to “close the gap” outlined in the UNAIDS report (6). This site has expressed interest in developing and incorporating mental healthcare into their clinic model. The clinic is interested in collaborating with this project to study the needs of patients through screening questionnaires and qualitative interviews. Our aim is to use the results of the study to identify high risk patients in need of mental health care. This collaboration would help to further the mission of the Tangerine Clinic that is “to provide quality HIV/AIDS prevention and care and conducting research relevant to Thailand and Southeast Asian region in order to reduce the impact of HIV/AIDS and related co-infections.”
-Screen patients using Thai versions of the PHQ9 and PTSD screening questionnaires, goal is to collect 500 questionnaires from HIV positive Transgender Tangerine Clinic Patients over 1 year.
-Conduct Qualitative Interview Evaluations of perceived past experiences and trauma experiences in approximately 30-50 patients to understand background and correlate with questionnaire scores.
Hypothesis: HIV positive transgender patients have higher rates of depression and PTSD than the general population. Patient with high scores likely have common traumas or experiences that may serve as a guide for identifying who would benefit most from trauma-based interventions and counseling.
- To identify specific common trauma experiences of HIV positive transgender patients.
- To determine prevalence of clinically significant PTSD symptoms among HIV positive transgender patients
- To determine prevalence of clinically significant depression symptoms among HIV positive transgender patients
- To assess the need for mental health treatment programs in HIV clinics such as the Tangerine Clinic based on disease prevalence and interest in treatment programs.
- To delineate what mental health services, medication versus counseling, could be offered to Tangerine Clinic Patients.
To address these aims, I plan to recruit patients at the Tangerine Clinic. I will conduct 50 qualitative interviews focusing on personal experiences surrounding their upbringing and HIV status to better understand the mental health and behavioral risk factors facing this population. I would like to investigate the role of mental health stigma in this interview as well, and assess patients for willingness to receive mental health treatment including counseling, medication or both. I also plan to provide these patients and an additional 450 patients with PTSD and depression screening questionnaires to assess the severity and prevalence of these mental health illnesses in this population. Based on the results of this study, I will make a recommendation to the Tangerine Clinic to incorporate mental health screening tools into the clinical practice in conjunction with provision of appropriate medication and counseling.
This study would provide background data demonstrating the need for development of mental health services in transgender HIV clinics, facilitate Thai Red Cross comprehensive mental health treatment of Transgender patients by developing screening tools to identify high risk patients, and potentially improve treatment outcomes for HIV positive transgender patients. Given the high risk of HIV transmission among transgender women throughout the world, findings from this study would be directly relevant to transgender women in the United States, especially Latina transgender women.