Transmen in San Francisco: What do We Know from HIV Test Site Data?

School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
AIDS and Behavior (Impact Factor: 3.49). 12/2010; 15(3):659-62. DOI: 10.1007/s10461-010-9859-9
Source: PubMed


The HIV epidemic has disproportionately affected marginalized populations. Societal marginalization contributes to the lack of appropriate prevention programs focusing on these populations, which in turn may contribute to ongoing HIV transmission. Transmen (female-to-male transgender persons) may also be a marginalized population at risk for HIV infection. Unfortunately, few studies that focus on transmen have been conducted. We considered the available existing data sources that may include members of the transmen population in San Francisco to describe what is known and what remains to be understood with respect to their risk for HIV. Data used for this descriptive analysis were collected at HIV test sites in 2009. In 2009, 59 unduplicated test seekers identified as transmen. While behavioral risk factors present in this study point to the high potential for HIV risk, there may still be low HIV prevalence and time to intervene. Lest we be caught off guard as another marginalized sexual minority experiences the tragedy of a rapid HIV epidemic, more detailed, specifically designed studies are needed to complete what we do not know about this population.

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    • "Over the past decade, a small but growing body of literature has documented sexual and drug-using behaviors of transgender persons that can lead to the acquisition or the transmission of sexually transmitted diseases (STDs), including HIV (Bockting, Benner, & Coleman, 2009; Bockting, Robinson, Forberg, & Scheltema, 2005; Bockting, Robinson, & Rosser, 1998; Chen, McFarland, Thompson, & Raymond, 2011; Clements-Nolle, Marx, Guzman, & Katz, 2001; Herbst et al., 2008; Kenagy, 2002, 2005; Kenagy & Bostwick, 2005; Kenagy & Hsieh, 2005; Reisner, Perkovich, & Mimiaga, 2010; Rowniak, Chesla, Rose, & Holzemer, 2011; Schulden et al., 2008; Sevelius, 2009; Stephens, Bernstein, & Philip, 2011; Winningham & Seal, 2003; Xavier et al., 2004; Xavier, Bobbin, Singer, & Budd, 2005). Studies have consistently found high rates of HIV infection and sexual risk behaviors among male-to-female (MTF) transgender women, particularly those who engage in transactional sex (California Department of Health Services, 2006; Clements-Nolle et al., 2001; Clements-Nolle, Guzman, & Harris, 2008; Elifson et al., 1993; Herbst et al., 2008; Kellogg, Clements-Nolle, Dilley, Katz, & McFarland , 2001; Kenagy, 2002; Nemoto, Operario, Keatley, Nguyen, & Sugano, 2005; Operario, Soma, & Underhill, 2008; Reback & Lombardi, 2001; Reisner et al., 2009; Simon, Reback, & Bemis, 2000; Xavier et al., 2005). "
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    ABSTRACT: The sexual health of female-to-male (FTM) transgender men remains understudied. De-identified electronic medical records of 23 FTMs (mean age = 32, 48% racial/ethnic minority) who screened for sexually transmitted diseases (STDs) between July and December 2007 at a Boston, Massachusetts area health center were analyzed. Almost half (48%) were on testosterone and 39% had undergone chest surgery; none had undergone genital reconstruction. The majority (57%) were bisexual, and 30% reported sex with nontransgender males only in the prior three months. One individual was HIV-infected (4.3%) and two (8.7%) had a history of STDs (all laboratory-confirmed). Overall, 26% engaged in sexual risk behavior in the prior three months (i.e., unprotected sex with a nontransgender male, condom breakage, or anonymous sex). The majority (61%) had a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis (52% depression, 52% anxiety, and 26% adjustment disorder), and regular alcohol use was common (65%). Alcohol use, psychosocial distress histories, and sex with males only (versus with males and females) were associated with sexual risk in the past three months. Transgender men have concomitant psychosocial health vulnerabilities which may contribute to sexual risk behaviors. Future research is needed to understand the myriad social, behavioral, and biological factors that contribute to HIV and STD vulnerability for FTMs.
    AIDS Care 11/2013; 26(7). DOI:10.1080/09540121.2013.855701 · 1.60 Impact Factor
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    • "As with prevalence estimates, for FTMs there is less information available about HIV-related sexual risk behaviours, though research suggests that some FTMs engage in high-risk sex, in particular those who have sex with cisgender male partners. Several small- to moderate-size studies report high proportions of FTMs engaging in high-risk sex, including unprotected receptive genital and anal sex [1,16-18]. Among 22 FTMs participating in an Ontario study of gay, bisexual and other men who have sex with men (MSM), about one third reported unprotected receptive anal sex in the past 6 months with a partner who was HIV-positive or of unknown status [19]; similar findings were recently reported among trans MSM in one U.S. region [20]. "
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    ABSTRACT: Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity. The Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups. Trans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions - 25% of female-to-male (FTM) and 51% of MTF individuals - had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible. Results suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.
    BMC Public Health 04/2012; 12(1):292. DOI:10.1186/1471-2458-12-292 · 2.26 Impact Factor
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    ABSTRACT: Human immunodeficiency virus (HIV) infection, first described in gay men over 30 years ago, remains an important medical issue to the lesbian, gay, bisexual, and transgender (LGBT) community. While HIV infection is an issue globally and nationally among all populations, in the United States, gay and bisexual men and male-to-female (MTF) transgender people are disproportionately affected. This article intends to serve as an update on the medical aspects of HIV care for the nonspecialist, including epidemiology, diagnosis, treatment, and prevention, with a focus on what is currently known about these aspects of HIV with respect to LGBT populations.
    Journal of Gay & Lesbian Mental Health 01/2013; 17(1):64-79. DOI:10.1080/19359705.2013.737738
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