Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.
"Transwomen face discrimination in schools as well as in mainstream employment. With few employment options, they transform their bodies through silicone and hormones to begin life in prostitution (De Santis, 2009), doubling the chance of HIV infection (Guadamuz et al., 2011) and four times more risk than FSW (Operario, Soma, & Underhill, 2008). Transwomen discrimination also constitutes an access barrier to medical care (Avery, Hellman, & Sudderth , 2001; Bockting, Robinson, Benner, & Scheltema , 2004; De Santis, 2009; Kenagy, 2005; Lombardi, 2007; Melendez & Pinto, 2009; Rachlin, Green, & Lombardi, 2008). "
[Show abstract][Hide abstract] ABSTRACT: Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419-7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996-15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310-4.339), experience of discrimination (OR = 3.962; CI = 1.540-10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118-6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required.
AIDS Care 08/2015; DOI:10.1080/09540121.2015.1066751 · 1.60 Impact Factor
"These data point to important next steps in research and prevention. Past prevention research has mostly targeted transwomen, and these data suggest that serving one side of the risk equation may not be enough to curb the epidemic within this hard hit population
. Indeed, it may be the lack of prevention resources provided to the sexual partners of transwomen that has contributed to the persistent high risk for HIV among transwomen, thus prevention messaging must be designed and targeted to sexual partners too. "
[Show abstract][Hide abstract] ABSTRACT: Background
Research on the sexual networks of transwomen is central to explaining higher HIV risk for this population. This study examined HIV risk behaviors and sexual mixing patterns of transwomen by demographic and HIV-related risk behaviors.
Data were obtained from a 2010 study of HIV risk for transwomen in San Francisco. Assortativity by race, partner type, HIV serostatus, and IDU across sexual networks was calculated using Newman’s assortativity coefficient (NC). Multivariable generalized estimating equations (GEE) logistic regression models were used to evaluate associations between unprotected anal intercourse with race and HIV serostatus, partner-IDU status and relationship type discordance while adjusting for the HIV status of transwomen.
There were 235 sexually active transwomen in this study, of whom 104 (44.3%) were HIV-positive and 73 (31.1%) had a history of injection drug use. Within the 575 partnerships, African American/black and Latina transwomen were the most racially assortative (NC 0.40, 95% CI 0.34-0.45, and NC 0.43, 95% CI 0.38-0.49, respectively). In partnerships where the partner’s HIV status was known (n = 309, 53.7%), most transwomen were in sexual partnerships with people of their same known serostatus (71.8%, n = 222). In multivariable analyses, unprotected anal intercourse was significantly associated with primary partners, having a sexual partner who was an injection drug user, and sexual partner seroconcordance.
Public health efforts to reduce transwomen’s HIV risk would likely benefit from prioritizing prevention efforts to risk reduction within IDU-discordant and primary partnerships, determining risks attributable to sexual network characteristics, and actively addressing injection drug use among transwomen.
"Methodological issues aside, the conceptual lack of distinction between sex, gender identity, and sexual orientation in many studies limits our current understanding of the complex interrelationships between these connected but not identical phenomena. In HIV research, for example, cisgender MSM and transgender women may share sex-linked biological risk factors (e.g., engaging in unprotected anal sex); however, unique factors related to gender identity may influence HIV acquisition and transmission behaviors for transgender women (e.g., differential power dynamics in primary sex partnerships compared to transactional sex encounters, receptive anal sex with primary partners and insertive anal sex with transactional sex partners, validation/ affirmation of gender identity in sexual encounters, injection silicone use) (Clements-Nolle, Marx, Guzman, & Katz, 2001; De Santis, 2009; Nemoto, Bodeker, Iwamoto, & Sakata, 2013; Nuttbrock et al., 2009, 2013; Silva-Santisteban et al., 2012). The lack of validated tools available to measure the construct we term natal sex/gender identity status is a barrier to getting survey items into health surveillance systems to monitor the health of transgender populations. "
[Show abstract][Hide abstract] ABSTRACT: Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54 %; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.
Archives of Sexual Behavior 07/2014; 43(8). DOI:10.1007/s10508-014-0314-2 · 3.53 Impact Factor
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