{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:53:43Z","timestamp":1791464023720,"version":"4.3.4"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Behav"],"DOI":"10.1007\/s10461-026-05326-9","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:00:51Z","timestamp":1791460851000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Syndemic Pattern of Sexualized Drug Use and Mental Distress Among Trans Women\/Khawaja Siras in Pakistan: Results From a Multicentric Latent Class Analysis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9168-5911","authenticated-orcid":false,"given":"Usman","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tehseen","family":"Azar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanzil ur","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoor","family":"Chaudary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Usman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"5326_CR1","volume-title":"Road map on implementation of transgender act in Pakistan","author":"U Ali","year":"2019","unstructured":"Ali U, Ali J. Road Map on Implementation of Transgender Act in Pakistan. Dostana Publications; 2019."},{"key":"5326_CR2","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1080\/26895269.2024.2303478","volume":"25","author":"A Alamgir","year":"2024","unstructured":"Alamgir A. We are struggling to seek justice: a study of the criminal justice system and transgender experiences in Pakistan. Int J Transgend Health. 2024;25:199\u2013214. https:\/\/doi.org\/10.1080\/26895269.2024.2303478.","journal-title":"Int J Transgend Health"},{"key":"5326_CR3","unstructured":"Mehta R. Decolonisation in Reverse: India\u2019s 2026 Transgender Amendment Act and the Return of the 1871 Criminal Tribes Act Rationale. ICONnect. 2026. Available at: https:\/\/www.iconnectblog.com\/decolonisation-in-reverse-indias-2026-transgender-amendment-act-and-the-return-of-the-1871-criminal-tribes-act-rationale\/. Accessed on 19 September 2026\/."},{"key":"5326_CR4","unstructured":"Aurangzaib Z. Invisible and unheard: transgender men in Pakistan and silent resistance to domestic practices and state authority. Global Campus of Human Rights 2026. Available at: https:\/\/www.gchumanrights.org\/preparedness\/invisible-and-unheard-transgender-men-in-pakistan-and-silent-resistance-to-domestic-practices-and-state-authority\/. Accessed on 19 September 2026."},{"key":"5326_CR5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3167\/ame.2025.200108","volume":"20","author":"C Fortier","year":"2025","unstructured":"Fortier C. Transsexual surgery in Egypt or the suspicion of homosexuality. Anthropol Middle East. 2025;20:127\u201340. https:\/\/doi.org\/10.3167\/ame.2025.200108.","journal-title":"Anthropol Middle East"},{"issue":"8","key":"5326_CR6","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.1016\/S2215-0366(23)00191-8","volume":"10","author":"MMA Riaz","year":"2023","unstructured":"Riaz MMA, Awan MM. Transgender rights in Pakistan: implications of Federal Shariat Court ruling. Lancet Psychiatry. 2023;10:e20. https:\/\/doi.org\/10.1016\/S2215-0366(23)00191-8.","journal-title":"Lancet Psychiatry"},{"key":"5326_CR7","unstructured":"Integrated Biological and Behavioural Surveillance among Key Populations in Pakistan, Round 6. 2025. Ministry of National Health Services, Regulation and Coordination. Available at: http:\/\/www.pdi-world.org\/pdi-projects.html. Accessed on 19 September 2026."},{"key":"5326_CR8","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1146\/annurev-anthro-100919-121009","volume":"50","author":"M Singer","year":"2021","unstructured":"Singer M, Bulled N, Ostrach B, Lerman Ginzburg S. Syndemics: a cross-disciplinary approach to complex epidemic events like COVID-19. Annu Rev Anthropol. 2021;50:41\u201358. https:\/\/doi.org\/10.1146\/annurev-anthro-100919-121009.","journal-title":"Annu Rev Anthropol"},{"key":"5326_CR9","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2023.101579","author":"DM Frost","year":"2023","unstructured":"Frost DM, Meyer IH. Minority stress theory: application, critique, and continued relevance. Curr Opin Psychol. 2023. https:\/\/doi.org\/10.1016\/j.copsyc.2023.101579.","journal-title":"Curr Opin Psychol"},{"key":"5326_CR10","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2025.2545302","author":"U Ali","year":"2025","unstructured":"Ali U, Samo RN, Riaz U, Ullah A, Shahswar Ali M, Ali SA, et al. Factors, practices and health needs of men who have sex with men, transgender and female sex workers engaged in sexualized drug use in Pakistan. AIDS Care - Psychol Socio-Medical Aspects AIDS\/HIV. 2025. https:\/\/doi.org\/10.1080\/09540121.2025.2545302.","journal-title":"AIDS Care - Psychol Socio-Medical Aspects AIDS\/HIV"},{"key":"5326_CR11","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1177\/23267836251388853","volume":"12","author":"A John","year":"2025","unstructured":"John A, Demant D, John A, Obeagu EI, Dar WM, Haider A, et al. Exploring demographics, depression, anxiety, and low body appreciation as correlates of suicide among transgender people in Pakistan. Violence Gend. 2025;12:140\u201350. https:\/\/doi.org\/10.1177\/23267836251388853.","journal-title":"Violence Gend"},{"key":"5326_CR12","doi-asserted-by":"publisher","first-page":"e63","DOI":"10.1097\/CCM.0000000000004710","volume":"49","author":"P Sinha","year":"2021","unstructured":"Sinha P, Calfee CS, Delucchi KL. Practitioner\u2019s Guide to Latent Class Analysis: Methodological Considerations and Common Pitfalls. Crit Care Med. 2021;49:e63\u201379. https:\/\/doi.org\/10.1097\/CCM.0000000000004710.","journal-title":"Crit Care Med"},{"key":"5326_CR13","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.29271\/jcpsp.2025.10.1294","volume":"2025","author":"U Ali","year":"2025","unstructured":"Ali U, Fatima B, Azmat S, Khan MS, Chaudhary R, Mirzazadeh A. The Effect of Emotional Intelligence and Employment on the Psychological Well-Being of HIV Key Population Workers. J Coll Physicians Surg Pakistan. 2025;2025:1294\u2013300. https:\/\/doi.org\/10.29271\/jcpsp.2025.10.1294.","journal-title":"J Coll Physicians Surg Pakistan"},{"issue":"4","key":"5326_CR14","doi-asserted-by":"publisher","first-page":"349","DOI":"10.29271\/jcpsp.2019.04.349","volume":"29","author":"R Azeem","year":"2019","unstructured":"Azeem R, Zubair UB, Jalil A, Kamal A, Nizami A, Minhas F. Prevalence of suicide ideation and its relationship with depression among transgender population. J Coll Physicians Surg Pak. 2019;29(4):349\u201352. https:\/\/doi.org\/10.29271\/jcpsp.2019.04.349.","journal-title":"J Coll Physicians Surg Pak"},{"key":"5326_CR15","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1108\/JPMH-07-2024-0086","volume":"24","author":"N Mansoori","year":"2025","unstructured":"Mansoori N, Ansarie M, Mubeen SM, Kanwal U. Unveiling mental health challenges: investigating depression, anxiety and stress among transgender individuals in Sindh, Pakistan. J Public Ment Health. 2025;24:234\u201343. https:\/\/doi.org\/10.1108\/JPMH-07-2024-0086.","journal-title":"J Public Ment Health"},{"key":"5326_CR16","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2018.30.96.12818","author":"HBU Shah","year":"2018","unstructured":"Shah HBU, Rashid F, Atif I, Hydrie MZ, Fawad MWB, Muzaffar HZ, et al. Challenges faced by marginalized communities such as transgenders in Pakistan. Pan Afr Med J. 2018. https:\/\/doi.org\/10.11604\/pamj.2018.30.96.12818.","journal-title":"Pan Afr Med J"},{"key":"5326_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.51709\/19951272\/Spring","volume":"17","author":"N Sherazi","year":"2023","unstructured":"Sherazi N, Najam N, Punjab P, Sadia J. Social Exclusion and Mental Health Issues of Transgender Community in Lahore City. FWU J Social Sci. 2023;17:1\u201315. https:\/\/doi.org\/10.51709\/19951272\/Spring.","journal-title":"FWU J Social Sci"},{"key":"5326_CR18","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.47391\/JPMA.11543","volume":"74","author":"M Wisal","year":"2024","unstructured":"Wisal M, Khan IA, Khan MK. Screening of musculoskeletal disorders and levels of depression in transgender people of Multan. J Pak Med Assoc. 2024;74:2145\u20139. https:\/\/doi.org\/10.47391\/JPMA.11543.","journal-title":"J Pak Med Assoc"},{"key":"5326_CR19","doi-asserted-by":"publisher","first-page":"779","DOI":"10.29271\/jcpsp.2023.07.779","volume":"33","author":"U Ali","year":"2023","unstructured":"Ali U, Ali SA. Prevalence of Depression and Subjective Job Stress Among Men who have Sex with Men and Transgender Community Health Workers in Pakistan. J Coll Physicians Surg Pakistan. 2023;33:779\u201383. https:\/\/doi.org\/10.29271\/jcpsp.2023.07.779.","journal-title":"J Coll Physicians Surg Pakistan"},{"key":"5326_CR20","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.65763","author":"KI Afzal","year":"2024","unstructured":"Afzal KI, Cheema A, Cheema H, Mournet A, Wei A, Khalid A, et al. Urdu-Language Translation and Validation of the Ask Suicide-Screening Questions (ASQ) Tool: A Focus on Connotation and Context. Cureus. 2024. https:\/\/doi.org\/10.7759\/cureus.65763.","journal-title":"Cureus"},{"key":"5326_CR21","first-page":"1166","volume":"68","author":"S Ahmad","year":"2018","unstructured":"Ahmad S, Hussain S, Akhtar F, Shah FS. Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression. J Pak Med Assoc. 2018;68:1166\u201370.","journal-title":"J Pak Med Assoc"},{"key":"5326_CR22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-078976","author":"IZ Aga","year":"2023","unstructured":"Aga IZ, Khurram SS, Karim M, Muzzamil M, Hashmi S, Shafique K. Employing telepsychiatry services to assess the prevalence and identify mental health disorders using the PHQ-9 and GAD-7 in resource-constrained regions of Dadar Mansehra, Pakistan: an observational cross-sectional study. BMJ Open. 2023. https:\/\/doi.org\/10.1136\/bmjopen-2023-078976.","journal-title":"BMJ Open"},{"key":"5326_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0006370","volume":"6","author":"U Ali","year":"2026","unstructured":"Ali U, Ali SA, Tirmizi SRH, Rehman T, Azar T, Yasin B, et al. Sexualized drug use, anxiety, depression, and suicidal ideation among men who have sex with men in Pakistan: results of a multi-center cross-sectional survey. PLoS Glob Public Health. 2026;6:e0006370. https:\/\/doi.org\/10.1371\/journal.pgph.0006370.","journal-title":"PLoS Glob Public Health"},{"key":"5326_CR24","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1111\/j.1553-2712.2011.01185.x","volume":"18","author":"JC Stoltzfus","year":"2011","unstructured":"Stoltzfus JC. Logistic regression: a brief primer. Acad Emerg Med. 2011;18:1099\u2013104. https:\/\/doi.org\/10.1111\/j.1553-2712.2011.01185.x.","journal-title":"Acad Emerg Med"},{"key":"5326_CR25","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1080\/02791072.2024.2367614","volume":"57","author":"L Muschialli","year":"2025","unstructured":"Muschialli L, Yang JC, Engstrom T, Puljevic C, Beltazar E, Beltazar E, et al. Sexualized drug use and chemsex: a bibliometric and content analysis of published literature. J Psychoactive Drugs. 2025;57:321\u201332. https:\/\/doi.org\/10.1080\/02791072.2024.2367614.","journal-title":"J Psychoactive Drugs"},{"key":"5326_CR26","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13080899","volume":"13","author":"M Ramazanova","year":"2025","unstructured":"Ramazanova M, Turdaliyeva B, Igissenova AI, Zhakupova M, Izbassarova AS, Seifuldinova M, et al. Prevalence of sexualized substance use and chemsex in the general population and among women: a systematic review and meta-analysis of cross-sectional studies. Healthcare (Basel). 2025;13:899. https:\/\/doi.org\/10.3390\/healthcare13080899.","journal-title":"Healthcare (Basel)"},{"key":"5326_CR27","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.3390\/ijerph19031704","volume":"19","author":"EM Jalil","year":"2022","unstructured":"Jalil EM, Torres TS, de Pereira A, Farias CC, Brito A, Lacerda JDU. High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. Int J Environ Res Public Health. 2022;19:1704. https:\/\/doi.org\/10.3390\/ijerph19031704.","journal-title":"Int J Environ Res Public Health"},{"key":"5326_CR28","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1080\/09540121.2020.1851017","volume":"33","author":"X Fan","year":"2021","unstructured":"Fan X, Lau JTF, Cai Y, Li J, Ma T, Gu J, et al. Prevalence and associated factors of sexualized drug use in sex work among transgender women sex workers in China. AIDS Care. 2021;33:1098\u2013106. https:\/\/doi.org\/10.1080\/09540121.2020.1851017.","journal-title":"AIDS Care"},{"key":"5326_CR29","doi-asserted-by":"publisher","first-page":"285","DOI":"10.2105\/AJPH.2011.300382","volume":"102","author":"ML Hatzenbuehler","year":"2012","unstructured":"Hatzenbuehler ML, O\u2019Cleirigh C, Grasso C, Mayer K, Safren S, Bradford J. Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. Am J Public Health. 2012;102:285\u201391. https:\/\/doi.org\/10.2105\/AJPH.2011.300382.","journal-title":"Am J Public Health"},{"key":"5326_CR30","unstructured":"Police believe case strong against transgender\u2019s. \u2018killer.\u2019 Dawn News 2016. Available at: https:\/\/www.dawn.com\/news\/1261593. Accessed on 19 September 2026."},{"key":"5326_CR31","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1037\/sgd0000391","volume":"9","author":"JA Puckett","year":"2022","unstructured":"Puckett JA, Tornello S, Mustanski B, Newcomb ME. Gender variations, generational effects, and mental health of transgender people in relation to timing and status of gender identity milestones. Psychol Sex Orientat Gend Divers. 2022;9:165\u201378. https:\/\/doi.org\/10.1037\/sgd0000391.","journal-title":"Psychol Sex Orientat Gend Divers"},{"key":"5326_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.inpsyc.2025.100049","volume":"37","author":"JO van Heesewijk","year":"2025","unstructured":"van Heesewijk JO, de Groot IL, Dreijerink KMA, Wiepjes CM, Kok AAL, van Schoor NM, et al. Mental health outcomes and loneliness in older transgender individuals receiving long-term gender-affirming hormone therapy compared with older cisgender individuals. Int Psychogeriatr. 2025;37:100049. https:\/\/doi.org\/10.1016\/j.inpsyc.2025.100049.","journal-title":"Int Psychogeriatr"},{"key":"5326_CR33","doi-asserted-by":"publisher","first-page":"101467","DOI":"10.1016\/j.copsyc.2022.101467","volume":"48","author":"DM Doyle","year":"2022","unstructured":"Doyle DM. Transgender identity: Development, management and affirmation. Curr Opin Psychol. 2022;48:101467. https:\/\/doi.org\/10.1016\/j.copsyc.2022.101467.","journal-title":"Curr Opin Psychol"},{"issue":"2","key":"5326_CR34","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1177\/1403494813511559","volume":"42","author":"A Br\u00e4nnlund","year":"2014","unstructured":"Br\u00e4nnlund A, Hammarstr\u00f6m A. Higher education and psychological distress: a 27-year prospective cohort study in Sweden. Scand J Public Health. 2014;42(2):155\u201362. https:\/\/doi.org\/10.1177\/1403494813511559.","journal-title":"Scand J Public Health"},{"key":"5326_CR35","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s10672-021-09395-x","volume":"34","author":"A Yousuf","year":"2022","unstructured":"Yousuf A, Khan NR, Khan MR, Ali A, Shaikh SA. Perceived National Culture and Perceived Organizational Support Effect on Transgender Employees Job Satisfaction. Empl Responsibilities Rights J. 2022;34:487\u2013513. https:\/\/doi.org\/10.1007\/s10672-021-09395-x.","journal-title":"Empl Responsibilities Rights J"},{"key":"5326_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7101a1","volume":"71","author":"AZ Ivey-Stephenson","year":"2022","unstructured":"Ivey-Stephenson AZ, Crosby AE, Hoenig JM, Gyawali S, Park-Lee E, Hedden SL. Suicidal Thoughts and Behaviors Among Adults Aged\u2009\u2265\u200918 Years \u2014 United States, 2015\u20132019. MMWR Surveillance Summaries. 2022;71:1\u201319. https:\/\/doi.org\/10.15585\/mmwr.ss7101a1.","journal-title":"MMWR Surveillance Summaries"},{"key":"5326_CR37","doi-asserted-by":"publisher","first-page":"983","DOI":"10.29271\/jcpsp.2023.09.983","volume":"33","author":"U Ali","year":"2023","unstructured":"Ali U, Pasha SK, Patel R, Schmidt HM, Altaf A. Assessment of Acceptability of Pre-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex with Men and Transgender Community in Pakistan. J Coll Physicians Surg Pakistan. 2023;33:983\u20139. https:\/\/doi.org\/10.29271\/jcpsp.2023.09.983.","journal-title":"J Coll Physicians Surg Pakistan"},{"key":"5326_CR38","doi-asserted-by":"publisher","first-page":"e1013091","DOI":"10.1371\/journal.pcbi.1013091","volume":"21","author":"DM Grijseels","year":"2025","unstructured":"Grijseels DM, Banqueri M, Iyer K, Hanlin L, Ortiz A, de la Campa M, Pagliaccio D, et al. Ten simple rules for queer data collection and analysis by STEM researchers. PLoS Comput Biol. 2025;21:e1013091. https:\/\/doi.org\/10.1371\/journal.pcbi.1013091.","journal-title":"PLoS Comput Biol"},{"key":"5326_CR39","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1089\/lgbt.2018.0241","volume":"6","author":"TJ Salway","year":"2019","unstructured":"Salway TJ, Morgan J, Ferlatte O, Hawkins B, Lachowsky NJ, Gilbert M. A systematic review of characteristics of nonprobability community venue samples of sexual minority individuals and associated methods for assessing selection bias. LGBT Health. 2019;6:205\u201315. https:\/\/doi.org\/10.1089\/lgbt.2018.0241.","journal-title":"LGBT Health"},{"key":"5326_CR40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004948","author":"U Ali","year":"2026","unstructured":"Ali U, Maqsood K, Ullah A, Rafiq B, Tariq N, Ali A, et al. Capacity needs of Pakistani psychiatrists to deliver community-sensitive mental health services to sexual minority men. PLOS Global Public Health. 2026. https:\/\/doi.org\/10.1371\/journal.pgph.0004948.","journal-title":"PLOS Global Public Health"}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05326-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-026-05326-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-026-05326-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:00:54Z","timestamp":1791460854000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10461-026-05326-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":40,"alternative-id":["5326"],"URL":"https:\/\/doi.org\/10.1007\/s10461-026-05326-9","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"1 October 2026","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2026","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"No competing financial or other interests exist","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}