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Original research
Characterising HIV and STIs among transgender female sex workers: a longitudinal analysis
  1. Tonia Poteat1,2,
  2. Rebecca Hamilton White3,
  3. Katherine H A Footer3,
  4. Ju Nyeong Park3,
  5. Noya Galai2,
  6. Steven Huettner4,
  7. Brad E Silberzahn3,5,
  8. Sean T Allen3,
  9. Jennifer Glick3,
  10. S Wilson Beckham3,
  11. Charlotte A Gaydos6,
  12. Susan G Sherman3
  1. 1Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5Department of Sociology, University of Texas at Austin, Austin, Texas, USA
  6. 6Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Tonia Poteat, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; tonia_poteat{at}


Objectives Though highly vulnerable to HIV and STIs, transgender female sex workers (TFSWs) are understudied in the US HIV and STI response. This study examined the correlates of laboratory-confirmed STIs among a cohort of 62 TFSWs followed over the course of 1 year and explored associations between specimen site and self-reported engagement in insertive and receptive anal intercourse.

Methods Participants completed an interviewer-administered computer-assisted personal interview at baseline, 3-, 6-, 9- and 12-month visits where self-administered anal swabs and urine samples for gonorrhea, chlamydia and trichomoniasis were also collected. HIV testing was conducted at baseline, 6-month and 12-month visits.

Results Baseline HIV prevalence was 40.3% with no HIV seroconversions over follow-up. Baseline prevalence of gonorrhea, chlamydia and trichomoniasis was 9.7%, 17.7% and 14.5%, respectively. In the multivariable regression modelling, recent arrest was significantly associated with testing positive for any STI (adjusted risk ratio (RR) 1.77; 95% CI: 1.10 to 2.84). Insertive anal sex with clients was associated with increased risk of testing positive for an STI via urine specimen (RR 3.48; 95% CI: 1.14 to 10.62), while receptive anal sex was not significantly associated with specimen site.

Conclusion Our findings confirm a high prevalence of STIs among TFSWs and highlight the importance of addressing structural drivers such as criminal justice involvement as well as the need to ensure screening for STIs at all anatomical sites regardless of self-reported sites of potential exposure. More research is needed to better understand HIV and STI vulnerabilities and appropriate interventions for TFSWs in the USA.

  • commercial sex
  • gonorrhea
  • chlamydia infection
  • trichomoniasis
  • transgender
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  • Handling editor Adam Huw Bourne

  • Contributors TP conceived of the manuscript, participated in data interpretation and wrote the initial draft; SGS and KHAF conceived of the parent study and contributed to manuscript drafts; RHW, JNP and NG analysed the data and contributed to manuscript drafts; SH, BES and STA participated in data collection, data interpretation and contributed to manuscript drafts; CAG participated in specimen analysis, data interpretation and manuscript drafts; JG and SWB contributed to manuscript drafts.

  • Funding This work was supported by the National Institute on Drug Abuse (NIDA) (R01DA038499-01) and Johns Hopkins University Center for AIDS Research (1P30AI094189). TP was supported by Johns Hopkins Institute for Clinical and Translational Research (KL2TR001077-05). JNP was supported by a Faculty Development Grant from the Johns Hopkins University Center for AIDS Research. STA was supported by the National Institutes of Health (NIH) (K01DA046234). JG was supported by NIH/NIDA (T32DA007292). CAG was supported by the National Institute of Biomedical Imaging and Bioengineering (U54007958) and the National Institute of Allergy and Infectious Diseases (U01068613). SGS has served as an expert witness in opioid litigation cases.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was reviewed and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified participant data are available from SSG at Johns Hopkins University: on reasonable request and review after submission of a manuscript concept form.

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