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HIV/AIDS and Transgender Persons
What We Know - A few facts
Although limited information is available about HIV/AIDS amongst transgender persons, HIV infection may be higher than average in this sector of the population.
- A Centers for Disease Control and Prevention (CDC) review of an outbreak of tuberculosis among a group of 26 transgender persons in Baltimore found that 62% were HIV infected.(1)
- Estimated HIV infection rates among specific transgender populations range from 14%-69% acccording to several transgender HIV/AIDS needs assesments and sexual risk behavior studies. The highest prevalence may be among male-to-female (MTF) transgender sex workers(2)
- Risky behaviors may be high among transgender persons, according to multiple transgender HIV/AIDS needs assessments. Risk factors include: multiple sexual partners, irregular condom use, unsafe injection practices (drugs and other substances including hormone and silicone injections); as well as lack of transgender-appropriate education and prevention activities. (2)
- Although HIV/AIDS risk behaviors may be reportedly high among transgender persons, many transgender persons self-identify as having low risk (according to various local HIV/AIDS needs assessments of non-infected individuals and those not previously tested for HIV).(2)
- Transgender people face stigma and discrimination, which exacerbates their HIV risk. The stigma of transgender status is associated with lower self-esteem, increased likelihood for substance abuse and survival sex work in MTF's, and lessened likelihood of safer sex practices. Social marginalization can result in the denial of education, employmen and housing opportunities (1-3)
- Ther are few transgender-sensitive HIV/AIDS prevention activities. In addition, access to care for HIV disease may be limited due to low socio-economic status, lack of insurance, fear of one's transgender status being revealed, provider lack of knowledge about caring for transgender persons, and provider discrimination (e.g., exclusion services such as drug rehabilitation programs, verbal harassment and mistreatment).(1-3)
- In a study of persons diagnosed with AIDS between 1990-2000, and reported to CDC from 3-4 states, transgender persons were more likely to be Black, Hispanic, or Asian Americans/Pacific Islanders, compared to other persons with AIDS.
What We Can Do
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Data. Improve data collection on transgender persons and HIV infection, particularly, separation of transgender people from the men-who-have-sex-with-men (MSM) category in data reporting. This can take place in partnerships between CDC, other researchers, and transgender communities.
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HIV/AIDS Prevention. HIV/AIDS is not always a priority issue in the transgender community because so many other basic survival issues outweigh it. In order to effectively reach this community, HIV/AIDS prevention and care programs might be incorporated into a broader outreach effort, such as job training or general acccess to health care.
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Education of Decision-Makers. Conduct outreach to educate policymakers, health providers, and others about transgender people and their concerns.
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Providers. Build provider competency to address transgender health and its relationship to HIV/AIDS transmission and prevention.
Defining Transgender Individuals whose gender identity, expression, or behavior is not traditionally associated with their birth sex. Some transgender individuals experience gender identity as incongruent with their anatomical sex and may seek some degree of sex reassignment surgery, take hormones, or undergo other cosmeetic procedures. Others may pursue gnder expression (masculine or feminine) through external self-presentation and behavior. There are no reliable data on the number of transgender individuals in the U.S. (4)
International Resources
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Asian Pacific AIDS Intervention Team, 605 West Olympic BLVD., #610 Los Angeles, CA 90015, 213-553-1845
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Gender Education & Advocacy, P.O. Box 65, Kensington, MD 20895, 301-949-3822, voice mailbox #8
www.gender.org -
International Journal of Transgenderism www.symposion.com/ijt
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LLEGO (National Latina/o Lesbian, Gay Bisexual & Transgender Organization), 1612 K Street, NW Suite 500, Washington, DC 20006, 202-466-8240
www.llego.org -
Positive Health Project, 301 West 37th Street, 2nd Floor, New York, NY 10018, 212-465-8304
www.positivehealthproject.org -
Proyecto ContraSIDA Por VIDA, 2973 16th Street, San Francisco, CA 94103, 415-864-7278
www.pcpv.org -
Safe Haven Outreach Ministry, 805 Florida Avenue NW, Washington, DC 20001, 202-299-0701
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TGNet Arizona, 2818 North Campbell, PMB 315, Tucson, AZ 85719, 520-742-5686
tgnetarizona.org -
TransHealth and HIV Education Development Program, 132 Boylston Street, 3rd Floor, Boston, MA 02116, 617-457-8150 ext. 342
www.jri.org
UK and Other Resources
Elton
John AIDS Foundation |
The
official, internet presence for the Elton John AIDS Foundation.
The site has been developed to provide a resource not only for
the Foundation, but for others seeking help. |
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Aids
Map |
HIV
& AIDS Treatment In Practice (HATIP) is a new, twice-monthly
email newsletter from NAM, aimed at doctors, clinicians, treatment
advocates and other healthcare workers in resource-limited settings.
Mainly UK site with many International links and resources. |
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The
National Aids Trust |
The National AIDS Trust (NAT) is the UK's leading HIV and AIDS policy development and advocacy organisation. NAT works in the UK and internationally for policies that will prevent HIV transmission, improve access to treatment, challenge HIV stigma and discrimination and secure the political leadership to effectively fight AIDS. |
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Terrence
Higgins Trust |
Perhaps the most famous AIDS trust in the World. THT Direct Helpline 0845 1221 200 can give you HIV information, advice and support over the phone. They might not have all the answers straight away, but they will know someone who has. Why not call now for peace of mind? It's open 10am - 10pm Monday - Friday, and 12 noon - 6pm on Saturday and Sunday. The Terrence Higgins Trust Fundraising Team is available to support you with any activity you choose to undertake. We can help you every step of the way with any advice, information, materials and moral support you might need. To find out more call the Fundraising Team on 020 7816 4615/4635 |
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AVERT |
AVERT is an international HIV and AIDS charity based in the UK, with the aim of AVERTing HIV and AIDS worldwide. AVERT has a number of overseas projects, helping with the problem of HIV/AIDS in countries where there is a particularly high rate of infection, such as South Africa, or where there is a rapidly increasing rate of infection such as in the Russian Federation. |
Research Papers
1 HIV-Related Turberculosis in a Transgender Network: Baltimore, Maryland, and New York City Area, 1998-2000." MMWR. April 20, 2000
2 Needs assesments on transgender persons and HIV/AIDS have been conducted in multiple sites. Data cited above refer to studies in Atlanta, Boston, Chicago, Los Angeles, Minnesota, New York City, Philadelphia, San Francisco, San Juan, and Washington, DC, with variable methods used to assess HIV status (i.e., self reported through confidential surveys/interviews as well as baseline HIV tests).
3 Bockting, Walter. Transgender HIV Prevention: A Minnesota Response to a Global Health Concern, 1998. Nemoto T, Luke D, Mamo L, Ching A, Patria J. HIV risk behaviors among male-to-female transgenders in comparison with homosexual or bisexual males and heterosexual females. AIDS Care 1999; 11:297-312. John Snow Research and Training Institute, Inc. "Access to Health Care for Transgendered Persons in Greater Boston." July 2000.
4 Definition by representatives of TLCA forum, January 2001
Department of Health and Human Services. The Leadership Campaign on AIDS is a program of the Office of HIV/AIDS Policy - (202) 690-5560 - www.surgeongeneral.gov/AIDS
HIV/AIDS in Transgendered & Transsexual Persons
Advisory
Gender Education & Advocacy recommends that all transsexual and
transgendered persons who engage in or have a history of unprotected
sexual relations with any other person examine their risk behaviors
and consider ways of reducing their risk of HIV/AIDS and other STDs.
Those who engage in high-risk behaviors or have done so in the past
should get tested to learn their HIV status, and then take appropriate
action to prevent transmission or reception of HIV and other STDs.
The Problem
The HIV/AIDS pandemic is the most significant health crisis facing
the world today. Nearly 800,000 cases of AIDS have been diagnosed
in the U.S. since the epidemic began over two decades ago, and an
estimated onequarter to one-third of Americans living with HIV are
unaware they are infected. According to the U.S. Centers for Disease
Control and Prevention (CDC), Men who have Sex with Men (MSMs) are
the singlehighest group at risk for HIV/AIDS, especially MSMs of Color.
With regard to HIV surveillance and prevention, it is the CDC’s
current practice not to separate MTF transgendered and transsexual
people from their MSM category, with no attention paid to the risks
of FTM transgendered people.
Discussion
Although it is impossible to determine the actual HIV seroprevalence
rate for transgendered and transsexual people in the U.S., recent
data from non-federal sources suggest they comprise one of the highest
at-risk populations in the U.S. Qualitative and quantitative needs
assessments of urban transgender populations performed over the past
seven years by various public health departments and organizations
have yielded a wealth of information, not only about sexual risk behaviors,
but also psychosocial and physical medical needs, access of and barriers
to health care, and other data.HIV seroprevalence in MTF transgendered
people has been reported in these studies as ranging from 14% to 35%.
Seroprevalence in MTF sex workers have been reported as high as 68%,
and they are often induced by their clients to engage in barrier-free
sex. HIV seroprevalence in FTM and female-bodied transgendered people
reported thus far has been low (1.6% to 3.3%). However, they too have
been found to engage in barrier-free sex, and an unknown percentage
of FTMs also identify themselves as gay and have sex with nontransgendered
men. Studies have also found significant substance abuse among transgendered
people, and needle sharing among FTMs and MTFs for hormonal injection
also has been reported.