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Original research
HIV and STI positivity rates among transgender people attending two large STI clinics in the Netherlands
  1. Susanne Drückler1,
  2. Ceranza Daans1,2,3,
  3. Elske Hoornenborg1,
  4. Henry De Vries1,4,
  5. Martin den Heijer2,3,
  6. Maria Prins1,5,
  7. Sophie Kuizenga Wessel6,
  8. Martijn van Rooijen7
  1. 1Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  2. 2Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Dermatology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam University Medical Centers, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  5. 5Division of Infectious Diseases, Amsterdam Institute for Infection & Immunity (AII), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  6. 6Department of Sexual Health, Public Health Service Haaglanden, The Hague, The Netherlands
  7. 7Department of informatics, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Dr Ceranza Daans, Amsterdam UMC Locatie VUmc, 1081 HV Amsterdam, The Netherlands; c.daans{at}


Background Global data show that transgender people (TGP) are disproportionally affected by HIV and sexually transmitted infections (STIs); however, data are scarce for Western European countries. We assessed gender identities, sexual behaviour, HIV prevalence and STI positivity rates, and compared these outcomes between TGP who reported sex work and those who did not.

Methods We retrospectively retrieved data from all TGP who were tested at the STI clinics of Amsterdam and The Hague, the Netherlands in 2017–2018. To identify one’s gender identity, a ‘two-step’ methodology was used assessing, first, the assigned gender at birth (assigned male at birth (AMAB)) or assigned female at birth), and second, clients were asked to select one gender identity that currently applies: (1) transgender man/transgender woman, (2) man and woman, (3) neither man nor woman, (4) other and (5) not known yet. HIV prevalence, bacterial STI (chlamydia, gonorrhoea and/or infectious syphilis) positivity rates and sexual behaviour were studied using descriptive statistics.

Results TGP reported all five categories of gender identities. In total 273 transgender people assigned male at birth (TGP-AMAB) (83.0%) and 56 transgender people assigned female at birth (TGP-AFAB) (17.0%) attended the STI clinics. Of TGP-AMAB, 14,6% (39/267, 95% CI 10.6% to 19.4%) were HIV-positive, including two new diagnoses and bacterial STI positivity was 15.0% (40/267, 95% CI 10.9% to 19.8%). Among TGP-AFAB, bacterial STI positivity was 5.6% (3/54, 95% CI 1.2% to 15.4%) and none were HIV-positive. Sex work in the past 6 months was reported by 53.3% (137/257, 95% CI 47.0% to 59.5%) of TGP-AMAB and 6.1% (3/49, 95% CI 1.3% to 16.9%) of TGP-AFAB. HIV prevalence did not differ between sex workers and non-sex workers.

Conclusion Of all TGP, the majority were TGP-AMAB of whom more than half engaged in sex work. HIV prevalence and STI positivity rates were substantial among TGP-AMAB and much lower among TGP-AFAB. Studies should be performed to provide insight into whether the larger population of TGP-AMAB and TGP-AFAB are at risk of HIV and STI.

  • transgender persons
  • HIV
  • sex work

Data availability statement

No data are available.

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Data availability statement

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  • SD and CD are joint first authors.

  • Handling editor Tristan J Barber

  • Contributors SD, CD, MvR, EH and HDV designed the study protocol. SD performed the statistical analysis. Results were thoroughly discussed by SD, CD, EH and MvR. SD and CD drafted the paper. All authors commented on draft versions and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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