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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).
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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).
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PrEP should be
Human Immunodeficiency Virus in Transgender Persons
Section snippets
Key points
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
References (63)
Development, risk, and resilience of transgender youth
J Assoc Nurses AIDS Care
(2010)- et al.
Worldwide burden of HIV in transgender women: a systematic review and meta-analysis
Lancet Infect Dis
(2013) HIV infection risk factors among male-to-female transgender persons: a review of the literature
J Assoc Nurses AIDS Care
(2009)"There's no pamphlet for the kind of sex I have": HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men
J Assoc Nurses AIDS Care
(2009)- et al.
From treatment to healing: the promise of trauma-informed primary care
Womens Health Issues
(2015) - et al.
HIV pre-exposure prophylaxis in transgender women- a subgroup analysis of the iPrEx trial
Lancet HIV
(2015) - et al.
HIV/AIDS epidemiology, pathogenesis, prevention, and treatment
Lancet
(2006) - et al.
Antiretroviral therapy adherence among transgender women living with HIV
J Assoc Nurses AIDS Care
(2010) - et al.
HIV in transgender communities- syndemic dynamics and a need for multicomponent interventions
J Acquir Immune Defic Syndr
(2010) Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people
(2017)
Global epidemiology of HIV infection and related syndemics affecting transgender people
J Acquir Immune Defic Syndr
Behavioral interventions to prevent HIV transmission and acquisition for transgender women: a critical review
J Acquir Immune Defic Syndr
Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review
AIDS Behav
HIV prevalence, sexual partners, sexual behavior and HIV acquisition risk among trans men, San Francisco, 2014
AIDS Behav
Characterizing the HIV prevention and care continua in a sample of transgender youth in the U.S
AIDS Behav
Diagnosed HIV infection in transgender adults and adolescents: results from the national HIV surveillance system, 2009-2014
AIDS Behav
Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color
Sex Roles
HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons - implications for public health intervention
Am J Public Health
Injustice at every turn - a report of the national transgender discrimination survey
Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals
J Sex Res
Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women
AIDS Behav
Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables
AIDS Care
HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
Int J Epidemiol
'It's really a hard life': love, gender and HIV risk among male-to-female transgender persons
Cult Health Sex
Barriers to gender-affirming care for transgender and gender nonconforming individuals
Sex Res Social Policy
The risk less known: female-to-male transgender persons' vulnerability to HIV infection
AIDS Care
Transgender people and HIV prevention- what we know and what we need to know, a call to action
J Acquir Immune Defic Syndr
Facilitators and barriers to participation in PrEP HIV prevention trials involving transgender male and female adolescents and emerging adults
AIDS Educ Prev
Comprehensive HIV prevention for transgender persons
Am J Public Health
Rapid HIV testing in transgender communities by community-based organizations in three cities
Public Health Rep
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.