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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’.

Traditional ‘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.