HIV Infection Risk Factors Among Male-to-Female Transgender Persons: A Review of the Literature
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.
Available from: Carl Kendall
- "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). "
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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.
Available from: Maria Cecilia Zea
- "Stigma and discrimination inhibit transgender women from seeking medical care. In addition, previous research has shown associations between experiences of stigma and discrimination due to transgender identity with increased rates of HIV, substance use, depression , suicide attempts, barriers to employment, and barriers to health care access (De Santis, 2009; Guadamuz et al., 2011; Sugano, Nemoto, & Operario, 2006). Health care providers are often insensitive or do not have the knowledge and experience to serve the transgender population (Guadamuz et al., 2011; Sugano et al., 2006). "
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ABSTRACT: This article examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N = 14) and a focus group (N = 11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data and quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections but also in carrying out procedures—sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.
Available from: Erin Wilson
- "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. "
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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.
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