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Transgender people are at high risk for HIV, but too little is known about prevention and treatment for this population
Liz Highleyman, 2016-03-11 07:40:00
Transgender women have among the highest
rates of HIV infection but little is known about HIV prevalence among trans
men, Tonia Poteat of Johns Hopkins Bloomberg School of Public Health said in a
plenary lecture on transgender health and HIV at the recent Conference on
Retroviruses and Opportunistic Infections (CROI 2016) in Boston – the first ever on this population at CROI. A growing
number of studies and prevention and treatment programmes are addressing
transgender populations, but more research is needed.
Dr Poteat noted that while mainstream
knowledge about transgender men and women is relatively new in the US and
Europe, largely thanks to celebrities such as Chaz Bono and Caitlyn Jenner,
people outside the male-female gender binary have long existed in many
cultures, such as the hijra in India.
The size of the transgender population is
uncertain, in part due to varying definitions. One estimate put the number of transgender
people in the US at approximately 700,000, or 0.3% of the population. Estimates
range from 0.1% to 0.5% in Europe, and from 0.7% to 2.9% in South Asia, where
some countries legally recognise a ‘third gender’.
‘one-step’ data collection approaches can make it difficult to accurately
identify trans people in HIV research. Many investigators have categorised
study participants according to either their current gender identity or their
assigned sex at birth, both of which can result in misclassification. A ‘two-step’
method that asks about both initial sex assignment and current identity is more
accurate and inclusive.
“The way you ask the question makes a big
difference,” Dr Poteat stressed.
For example, the international iPrEx trial of
tenofovir/emtricitabine (Truvada) for
pre-exposure prophylaxis (PrEP)
included transgender women in its population of 2499 men who have sex with men.
The initial published iPrEx report said the study included just 29 trans women, but
a later analysis used
a broader definition – including people assigned male at birth who identified
as women, trans or ‘travesti’, and those who identified as men but used
feminising hormones – bringing the total up to 339.