Human Immunodeficiency Virus in Transgender Persons

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Key points

  • Transgender individuals are vulnerable to stigma, discrimination, and economic marginalization, which can potentiate negative health outcomes, including infection with human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).

  • Regular clinical risk assessments that include a comprehensive sexual history should be used to provide recommendations for HIV and STI screening and to identify individuals who would benefit from HIV preexposure prophylaxis (PrEP).

  • PrEP should be

Human immunodeficiency virus incidence and prevalence among transgender populations

HIV prevalence data for transgender populations must be interpreted within the context of widespread stigma and pervasive discrimination. A confluence of structural, social, biological, and individual level factors intersect producing social inequities, including high rates of unemployment, poverty, and homelessness among transgender people that negatively impact health outcomes and perpetuate HIV transmission.2, 4 Reliable estimates of the burden of HIV infection among transgender populations

Sexuality and human immunodeficiency virus risk among transgender populations

An important component of providing quality health care is ascertaining an individual’s sexual orientation, regardless of their gender identity.13 A diversity of sexual identities have been reported by transfeminine and transmasculine individuals, including heterosexual or opposite-gender, lesbian/gay or same-gender, pansexual, bisexual, queer, and asexual orientations, among others.14, 15 In addition, the types of sex and levels of HIV risk may vary among transgender people.4, 16

Emerging

Human Immunodeficiency Virus Testing

The US Preventive Services Task Force recommends that all adolescents and adults 15 to 65 years of age be screened at least once for HIV infection regardless of their level of exposure risk.34 Per CDC national guidelines, individuals at increased risk for HIV should be screened at least annually.35 In the authors’ opinion, transgender people with an increased risk of HIV exposure should undergo testing at least every 6 to 12 months; however, more frequent testing may be warranted for

Engagement in human immunodeficiency virus care and clinical outcomes for transgender populations

Transgender individuals often face stigma, discrimination, and poverty that may prevent adequate access to necessary health care services.14 When seeking HIV-related health care services, compounding factors may discourage HIV-positive transgender individuals from engaging in and remaining in care, including fear and shame associated with the diagnosis, concerns about legal repercussions related to the circumstances by which the infection was acquired, and apprehension regarding potential

Drug interactions between antiretroviral medications and hormone therapy

Research suggests gender-affirming care (eg, hormone therapy) is frequently prioritized over other health care needs, including HIV prevention and treatment services, particularly if there is concern about potential interactions between hormone therapy and ART or PrEP.13, 40, 57 Health care workers providing care for transgender people living with HIV should be aware of potential drug-drug interactions between hormone therapy and antiretroviral agents. Current recommended ART regimens for

Summary

The interplay between psychosocial, behavioral, and societal factors that potentiate vulnerability to HIV necessitates the design and implementation of multicomponent HIV prevention and treatment efforts for transgender populations.2 Ideally, these efforts would include education for transgender adults and adolescents regarding HIV risk factors and safer sex practices, improved access to HIV prevention and treatment services, integration of gender-affirming care, including access to hormone

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References (63)

  • T. Poteat et al.

    Global epidemiology of HIV infection and related syndemics affecting transgender people

    J Acquir Immune Defic Syndr

    (2016)
  • R. Garofalo et al.

    Behavioral interventions to prevent HIV transmission and acquisition for transgender women: a critical review

    J Acquir Immune Defic Syndr

    (2016)
  • Centers for Disease Control and Prevention. CDC-Funded HIV Testing: United States, Puerto Rico and the U.S. Virgin...
  • J.H. Herbst et al.

    Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review

    AIDS Behav

    (2008)
  • W. McFarland et al.

    HIV prevalence, sexual partners, sexual behavior and HIV acquisition risk among trans men, San Francisco, 2014

    AIDS Behav

    (2017)
  • S.L. Reisner et al.

    Characterizing the HIV prevention and care continua in a sample of transgender youth in the U.S

    AIDS Behav

    (2017)
  • H. Clark et al.

    Diagnosed HIV infection in transgender adults and adolescents: results from the national HIV surveillance system, 2009-2014

    AIDS Behav

    (2017)
  • J.M. Sevelius

    Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color

    Sex Roles

    (2012)
  • K. Clements-Nolle et al.

    HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons - implications for public health intervention

    Am J Public Health

    (2001)
  • J.M. Grant et al.

    Injustice at every turn - a report of the national transgender discrimination survey

    (2011)
  • L.E. Kuper et al.

    Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals

    J Sex Res

    (2012)
  • D. Operario et al.

    Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women

    AIDS Behav

    (2011)
  • T. Nemoto et al.

    Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables

    AIDS Care

    (2014)
  • R.F. Baggaley et al.

    HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention

    Int J Epidemiol

    (2010)
  • R.M. Melendez et al.

    'It's really a hard life': love, gender and HIV risk among male-to-female transgender persons

    Cult Health Sex

    (2007)
  • J.A. Puckett et al.

    Barriers to gender-affirming care for transgender and gender nonconforming individuals

    Sex Res Social Policy

    (2018)
  • G.P. Kenagy et al.

    The risk less known: female-to-male transgender persons' vulnerability to HIV infection

    AIDS Care

    (2005)
  • K.H. Mayer et al.

    Transgender people and HIV prevention- what we know and what we need to know, a call to action

    J Acquir Immune Defic Syndr

    (2016)
  • C.B. Fisher et al.

    Facilitators and barriers to participation in PrEP HIV prevention trials involving transgender male and female adolescents and emerging adults

    AIDS Educ Prev

    (2017)
  • M.S. Neumann et al.

    Comprehensive HIV prevention for transgender persons

    Am J Public Health

    (2017)
  • J.D. Schulden et al.

    Rapid HIV testing in transgender communities by community-based organizations in three cities

    Public Health Rep

    (2008)
  • Cited by (0)

    Disclosure Statement: Dr T. Poteat has received research grants to her institution from Gilead Sciences and ViiV Healthcare. Dr C.F. Kelley has received research grants to her institution from Gilead Sciences. Dr C.G. Ackerley has nothing to disclose.

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