The COVID-19 pandemic has exacerbated existing challenges Asian Americans and Pacific Islanders (AAPIs) face in accessing healthcare: language access, barriers for immigrant populations, lack of data disaggregation, and lack of community resources. AAPIs also have increased vulnerability to COVID-19 due to higher representation in specific labor sectors. These challenges take place in the context of increasing anti-Asian hate and xenophobia. This article focuses on one organization addressing these challenges: the Asian & Pacific Islander American Health Forum (APIAHF). We will describe how APIAHF is using narrative change, structural change, and community change to address pandemic-related emergent and longer-term needs and how funding structures and critical partnerships with a variety of stakeholders support these efforts.

For transgender (trans) women, community belonging may play an important role in shaping perceptions of HIV Pre-exposure Prophylaxis (PrEP). A cluster analysis was performed using data obtained from a survey administered to 128 trans women residing in Philadelphia, PA and the San Francisco Bay area, CA. Six items assessing feelings of community belongingness among trans women produced three distinct clusters. Associations were examined between cluster membership and perceptual items including beliefs about PrEP, experiences with healthcare, patient self-advocacy, and perceived trusted sources for PrEP information. Clusters were demographically comparable apart from age. There were significant differences noted between trust in various communication channels and perceptions of PrEP; the least community-connected cluster had less trust and more negative perceptions of PrEP. Analyses suggest that psychographic differences exist based on perceived community belongingness in this population, and this in turn may be consequential in determining how information about PrEP is communicated and diffused to trans women for whom PrEP may be indicated.

Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.

Background

Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use.

Methods

This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues.

Results

Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP's effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication.

Conclusions

Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.

A long-standing paradigm in astrophysics is that collisions-or mergers-of two neutron stars form highly relativistic and collimated outflows (jets) that power γ-ray bursts of short (less than two seconds) duration. The observational support for this model, however, is only indirect. A hitherto outstanding prediction is that gravitational-wave events from such mergers should be associated with γ-ray bursts, and that a majority of these bursts should be seen off-axis, that is, they should point away from Earth. Here we report the discovery observations of the X-ray counterpart associated with the gravitational-wave event GW170817. Although the electromagnetic counterpart at optical and infrared frequencies is dominated by the radioactive glow (known as a kilonova') from freshly synthesized rapid neutron capture (r-process) material in the merger ejecta, observations at X-ray and, later, radio frequencies are consistent with a short γ-ray burst viewed off-axis. Our detection of X-ray emission at a location coincident with the kilonova transient provides the missing observational link between short γ-ray bursts and gravitational waves from neutron-star mergers, and gives independent confirmation of the collimated nature of the γ-ray-burst emission.

The discovery of the electromagnetic counterparts to the binary neutron star merger GW170817 has opened the era of GW+EM multi-messenger astronomy. Exploiting this breakthrough requires increasing samples to explore the diversity of kilonova behaviour and provide more stringent constraints on the Hubble constant, and tests of fundamental physics. LSST can play a key role in this field in the 2020s, when the gravitational wave detector network is expected to detect higher rates of merger events involving neutron stars ($\sim$10s per year) out to distances of several hundred Mpc. Here we propose comprehensive target-of-opportunity (ToOs) strategies for follow-up of gravitational-wave sources that will make LSST the premiere machine for discovery and early characterization for neutron star mergers and other gravitational-wave sources.

A search is presented for a heavy resonance Formula Presented decaying into a Standard Model Higgs boson Formula Presented and a new particle Formula Presented in a fully hadronic final state. The full Large Hadron Collider run 2 dataset of proton-proton collisions at Formula Presented collected by the ATLAS detector from 2015 to 2018 is used and corresponds to an integrated luminosity of Formula Presented. The search targets the high Formula Presented-mass region, where the Formula Presented and Formula Presented have a significant Lorentz boost in the laboratory frame. A novel application of anomaly detection is used to define a general signal region, where events are selected solely because of their incompatibility with a learned background-only model. It is constructed using a jet-level tagger for signal-model-independent selection of the boosted Formula Presented particle, representing the first application of fully unsupervised machine learning to an ATLAS analysis. Two additional signal regions are implemented to target a benchmark Formula Presented decay into two quarks, covering topologies where the Formula Presented is reconstructed as either a single large-radius jet or two small-radius jets. The analysis selects Higgs boson decays into Formula Presented, and a dedicated neural-network-based tagger provides sensitivity to the boosted heavy-flavor topology. No significant excess of data over the expected background is observed, and the results are presented as upper limits on the production cross section Formula Presented) for signals with Formula Presented between 1.5 and 6 TeV and Formula Presented between 65 and 3000 GeV.