TRANSGENDER
[Main List]
Fact Sheets
What Are the HIV Prevention Needs of Male-to-Female Transgender Persons?
Center for AIDS Prevention Studies, University of California, San Francisco (CAPS, UCSF), September 2001
http://www.caps.ucsf.edu/pubs/FS/MTF.php
Human Hormone Basics
Center for AIDS Prevention Studies, University of California, San Francisco (CAPS, UCSF)
http://www.caps.ucsf.edu/projects/Transitions/pdf/HormoneBasics.pdf
Reports
Serving Transgender People in California: Assessing Progress, Advancing Excellence
Jae Sevelius, Ph.D., JoAnne Keatley, M.S.W., James Rouse Iñiguez, M.A.
and E. Michael Reyes, M.D., M.P.H.
Center of Excellence for Transgender HIV Prevention, 2008
http://transhealth.ucsf.edu/pdf/serving-trans-ca.pdf\
Transgender people are highly vulnerable and marginalized in the United States. Experiences of discrimination are common when seeking to obtain basic human necessities such as employment, housing, and health care, as are reports of violence and harassment (1-8). It comes as no surprise then, given the association of negative health outcomes with stigma and discrimination, that transgender people, and transgender women and transgender people of color in particular, experience severe health disparities across a number of outcomes, including HIV (5, 9, 10).
In California, transgender female clients of publicly-funded counseling and testing sites have higher rates of HIV diagnosis (6%) than all other risk categories, including MSM (4%) and partners of people living with HIV (5%), and African American transgender women have a substantially higher rate of HIV diagnosis (29%) than all other racial or ethnic groups of transwomen (16). Estimates from California’s urban centers also suggest that HIV prevalence rates among transgender women are extremely high, especially for transgender women of color and African American transgender women in particular (2, 15). Regional estimates include 16 - 60% in San Francisco (2, 17-20) and 22 - 52% in Los Angeles (21, 22) with the highest rates consistently being reported among African American transgender women.
Once in a Blue Moon: Toward a Better Understanding of Heterosexually Identified Men who Have Sex with Men and/or Preoperative Transgender Women.
Report for the City of Los Angeles, AIDS Coordinator. Los Angeles.
Reback, C.J. & Larkins, S. (2006).
Articles and Presentations
Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review
Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N
AIDS Behav. 2008;12(1):1-17.
http://www.medscape.com/viewarticle/571708
Transgender populations in the United States have been impacted by the HIV/AIDS epidemic. This systematic review estimates the prevalence of HIV infection and risk behaviors of transgender persons. Comprehensive searches of the US-based HIV behavioral prevention literature identified 29 studies focusing on male-to-female (MTF) transgender women; five of these studies also reported data on female-to-male (FTM) transgender men. Using meta-analytic approaches, prevalence rates were estimated by synthesizing weighted means. Meta-analytic findings indicated that 27.7% (95% confidence interval [CI], 24.8-30.6%) of MTFs tested positive for HIV infection (four studies), while 11.8% (95% CI, 10.5-13.2%) of MTFs self-reported being HIV-seropositive (18 studies). Higher HIV infection rates were found among African-American MTFs regardless of assessment method (56.3% test result; 30.8% self-report). Large percentages of MTFs (range, 27-48%) reported engaging in risky behaviors (e.g., unprotected receptive anal intercourse, multiple casual partners, sex work). Prevalence rates of HIV and risk behaviors were low among FTMs. Contextual factors potentially related to increased HIV risk include mental health concerns, physical abuse, social isolation, economic marginalization, and unmet transgender-specific healthcare needs. Additional research is needed to explain the causes of HIV risk behavior of transgender persons. These findings should be considered when developing and adapting prevention interventions for transgender populations.
Investigation of the High HIV Prevalence in the Transgender African American Community in San Francisco
Rose VK, Scheer S, Shafer KP, Balls J, McFarland WC;
San Francisco Department of Public Health, San Francisco; Center for AIDS Prevention Studies, University of California, San Francisco
Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. TuOrE1157.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102251910.html
http://www.hawaii.edu/hivandaids/High%20HIV%20Prevalence%20in%20the%20Transgender%20African%20American%20Community.pdf
ISSUES: A recent study among the estimated 3000 transgendered people in San Francisco revealed a significantly higher HIV prevalence among the African American transgender population than other racial/ethnic transgendered groups. Sexual and drug use behavior was determined to be similar among transgendered people of all races; therefore, the higher HIV seroprevalence rate among African American transgendered people warranted further investigation of the reasons for the difference among this population. DESCRIPTION: A rapid assessment methodology was undertaken to examine the issues related to HIV prevalence among African American transgendered people. Key informant interviews and focus groups were conducted, and a quantitative survey was administered. LESSONS LEARNED: Primary concerns of African American transgendered people center on mental health issues unrelated to HIV infection. Among the myriad of concerns faced by this marginalized population, including employment and housing discrimination based on race and gender identification; HIV did not register as a high priority. Sex work, incarceration and survival sex confer significant risk for HIV infection. Partner selection and partner sharing may contribute to the unexplained differences in HIV prevalence. RECOMMENDATIONS: HIV prevention programs using ecological theory and principles are more likely to attract transgendered people than programs that do not consider the context of transgendered people's lives. Health and mental health care providers need enhanced sensitivity training to understand the multitude of issues facing African American transgendered people, and to combat the stigma associated with their lives and behaviors. Issues of self-esteem and social capital should be addressed in provider training. Risk assessment methods should be strengthened to document the behaviors that increase risk for HIV transmission and other sexually transmitted diseases.
Critical Health Needs for MTF Transgenders of Color
Tooru Nemoto, PhD, JoAnne Keatley, MSW, Lally Adao, Anna Fernandez, Breonna McCree, Pedro Arista, Melenie Eleneke, Don Operario, PhD, Toho Soma, Christine Soriano
Center for AIDS Prevention Studies, UCSF, 2002
http://www.caps.ucsf.edu/projects/TRANS/pdf/TRANScriticalneeds.pdf
An investigation of HIV risk in the lives of MTF transgenders of color. We interviewed over 300 African Americans, Asians & Pacific Islanders (APIs), and Latinas from the San Francisco community. Participants discussed numerous risk behaviors that contribute to HIV risk—including unprotected sex, drug use, and sharing injection needles—and how their social environments increase HIV risk throughout the community. Based on our findings, we have developed two programs to address substance abuse and mental health needs in the MTF transgender community.
Main Findings: Distressing HIV rates throughout the MTF transgender community. Overall, 26% of our sample reported being HIV positive: 42% African Americans, 23% Latinas, and 13% APIs. Other serious health risks impact the transgender community, including high rates of Tuberculosis, Hepatitis C, and STDs. Systems of social oppression contribute to health risk, such as racism, transphobia, economic hardship, and lack of socioeconomic resources. Health care systems must address high levels of substance abuse throughout the community. Psychological service providers must address unmet mental health needs in the transgender community.
HIV Risk Behaviors among Male-to-Female Transgender Persons of Color in San Francisco
Tooru Nemoto, PhD, Don Operario, PhD, JoAnne Keatley, MSW, Lei Han, PhD and Toho Soma, MPH
Center for AIDS Prevention Studies, University of California, San Francisco.
July 2004, Vol 94, No. 7 | American Journal of Public Health 1193-1199
http://www.ajph.org/cgi/content/abstract/94/7/1193
Objectives. The authors examined HIV risk behaviors among African American, Asian/Pacific Islander (API), and Latina male-to-female (MTF) transgender persons in order to improve HIV prevention programs.
Methods. Individual survey interviews with MTF transgender persons of color (n = 332; 112 African Americans, 110 Latinas, and 110 APIs) were conducted.
Results. Prevalence and correlates of receptive anal sex and unprotected receptive anal sex (URAS) varied by type of partner (primary, casual, or commercial sex partners). URAS with primary partners was associated with drug use before sex; URAS with casual partners was associated with HIV-positive status and drug use before sex; and URAS with commercial sex partners was associated with African American ethnicity and low income.
Conclusions. Findings on current risk behaviors among MTF transgender persons provided meaningful implications for HIV prevention interventions.
Substance Abuse and HIV Risk Behaviors among Transgender Women in the San Francisco Bay Area
Tooru Nemoto, Ph.D., Jeanna Eichenbaum, MSW, Jae Sevelius, Ph.D., Mary Hsueh, Angel Manaois, Kathryn Steuerman, Andrea Horne, Breonna McCree, & Ari Rinzler
Center for AIDS Prevention Studies, University of California, San Francisco
http://www.caps.ucsf.edu/pubs/presentations/pdf/nemoto_apha.pdf
Male-to-female (MTF) transgenders are at high risk for HIV infection due to their unique social context (e.g., substance abuse, sex work, transphobia, and lack of access to health care and social services). Phase I of the study described substance use and HIV risk behaviors among transgender women of color in San Francisco based on qualitative and quantitative data (See Nemoto et al., 2004a; 2004b). Phase II, utilizing the same methodology, expanded the sample to include white transgender women in San Francisco and African American transgender women in Oakland.
The preliminary data analysis on the focus groups of Phase II revealed differences in gender identity and sexual orientation between African American transgender women residing in Oakland and white transgender women residing in San Francisco. African American participants perceived a need to use drugs to engage in sex work.
“Whenever I got high, I would go get ready to go ho. I could clip real good when I’m high, I be like, ‘Hi baby, how you doing?’ I could [do] all that real good.”
- African American participant
African American Community and HIV
Cseneca Greenwood, Mario Ruberte
East Bay AIDS Education and Training Center, April 9, 2004
http://www.hawaii.edu/hivandaids/African_American_Transgenders_and_HIV.ppt
Sex Work And HIV Status Among Transgender Women: Systematic Review And Meta-Analysis.
J Acquir Immune Defic Syndr. 2008 May 1;48(1):97-103.
Operario D, Soma T, Underhill K.
Department of Social Policy and Social Work, University of Oxford, Oxford, UK. don.operario@socres.ox.ac.uk
BACKGROUND: Transgender women are a key risk group for HIV, and epidemiologic studies have attributed high rates of HIV infection to behaviors associated with sex work in this population. This systematic review compared HIV prevalence among transgender female sex workers (TFSWs) with prevalence among transgender women who do not engage in sex work, male sex workers, and biologically female sex workers. METHODS: We conducted systematic searches of 6 electronic databases, and including studies that met pre-established criteria. We extracted data, appraised methodologic quality, assessed heterogeneity, and organized meta-analyses by comparison group. RESULTS: We identified 25 studies among 6405 participants recruited from 14 countries. Overall crude HIV prevalence was 27.3% in TFSWs, 14.7% in transgender women not engaging in sex work, 15.1% in male sex workers, and 4.5% in female sex workers. Meta-analysis indicated that TFSWs experienced significantly higher risk for HIV infection in comparison to all other groups (relative risk [RR] = 1.46, 95% confidence interval [CI]: 1.02 to 2.09), and particularly in comparison to female sex workers (RR = 4.02, 95% CI: 1.60 to 10.11). We observed significant heterogeneity among the included studies, along with methodologic limitations and imprecise definitions of sex work and gender. CONCLUSIONS: TFSWs could benefit from targeted HIV prevention interventions, HIV testing, and interventions to help reduce the risk of contracting or transmitting HIV. Structural interventions to reduce reliance on sex work among transgender women may be warranted.
Men Who Have Sex with Transgender Women: Challenges to Category-Based HIV Prevention.
AIDS Behav. 2008 Jan;12(1):18-26.
Operario D, Burton J, Underhill K, Sevelius J.
Department of Social Policy and Social Work, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, UK. don.operario@socres.ox.ac.uk
Full text http://www.springerlink.com/content/v5kp34g167q74r8u/fulltext.pdf
Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men's identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.
HIV prevalence, risk behaviors, health care use, and mental health status of transgendered persons in San Francisco: Implications for public health intervention.
Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001).
American Journal of Public Health, 91(6), 915-921.
http://www.ajph.org/cgi/content/abstract/91/6/915
OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
HIV prevention and health service needs of the transgender community in San Francisco.
Clements-Nolle., K, Wilkinson, W., Kitano, K., & Marx, R.
International Journal of Transgenderism. Volume 3, Number 1+2, January-June 1999. Special issue on Transgender and HIV: Risks, Prevention, and Care.
http://www.symposion.com/ijt/hiv_risk/clements.htm
Abstract
Objective: To qualitatively describe the level of HIV risk behaviors and access to HIV-prevention and health services among transgendered individuals in San Francisco.
Methods: Eleven focus groups were conducted with 100 Male-To-Female and Female-To-Male transgendered individuals. Focus groups were transcribed, reviewed, and comments were coded into categories that emerged naturally from the data. Unduplicated comments were enumerated and summarized.
Findings: HIV risk behaviors such as unprotected sex, commercial sex work, and injection drug use were common. Low self-esteem, economic necessity, and substance abuse were cited as common barriers to adopting and maintaining safer behaviors. Many individuals did not access prevention and health services because of competing priorities and the insensitivity of service providers. Participants’ recommendations for improving services include hiring transgendered persons to develop and implement programs and training existing providers in transgender sensitivity and standards of care.
A Rapid Needs Assessment: Transgender Male Risk for HIV in San Francisco, 2008
Principal Investigator: Hale Thompson
A community-based participatory research approach was utilized to design and conduct 47 surveys, 3 focus groups (n=17), and 10 key informant interviews. Two workshops and one town hall have been conducted to give community members and stakeholders an opportunity to interact with, analyze and discuss preliminary data and findings in order to give feedback and insights around recommendations and next steps. The assessment data shows that FTMs are engaging in risky sexual behaviors, particularly frontal receptive sex with multiple male partners. The data also suggests that the frontal region may undergo physiological changes with testosterone therapy that may make it more susceptible to HIV transmission than the female vagina. While the assessment found that some FTMs utilize a range of protective strategies to reduce risks for HIV, both risk-taking and risk-reduction behaviors occur within a context of vulnerabilities related to various transgender and gender-related stigmas; these vulnerabilities, or cofactors, include economic marginalization, low self-esteem and fear of rejection by sexual partners, regular drug and alcohol use, limited access to culturally competent testing, a lack of community and social support and histories of violence and abuse. These vulnerabilities, also referred to as syndemic effects, around HIV signify the conditions for a possible surge in HIV incidence among the FTM population without intervention.