HIV and Trans Women: A Literature Review

Transgend Health. 2018; 3(1): 239–250

Abstract:

Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom.

This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology.

We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care.

We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services.

There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.

Transgender women taking PrEP have lower levels of PrEP drugs than cisgender men

aidsmap/nam, November 9th 2018

A study presented at October’s HIV Research for Prevention conference (HIVR4P) in Madrid shows that transgender women who are taking feminising hormones and also taking pre-exposure prophylaxis (PrEP) have levels of the PrEP drugs tenofovir and emtricitabine in their blood that are about 25% lower than those in cisgender men, and levels in rectal tissue cells about 40% lower. Tenofovir levels in rectal tissue were 44% lower.

However, the study also confirmed that the interaction between hormones and PrEP did not appear to go the other way; blood levels of estradiol, the one hormone all of the transgender women took in one form or another, do not appear to be affected by PrEP.

 

National LGBT Survey: Research report [UK]

Government Equalities Office, July 2018

The Government Equalities Office launched a national LGBT survey in July 2017 in order to develop a better understanding of the lived experiences of lesbian, gay, bisexual and transgender people, and people who identify as having any other minority sexual orientation or gender identity, or as intersex.

The survey was open for 12 weeks and received 108,100 valid responses through an
anonymous online questionnaire that collected the experiences and views of
individuals who self-identified as having a minority sexual orientation or gender
identity, or as intersex, and were aged 16 or above and living in the UK. The survey placed an emphasis on issues relating to personal safety, education, the
workplace and healthcare. These were selected because existing evidence on the
experiences of LGBT people and their life outcomes tells us that these are the main
areas in which inequalities exist.

 

 

Using Chosen Names Reduces Odds of Depression and Suicide in Transgender Youths

The University of Texas at Austin, Tue, April 3, 2018

In one of the largest and most diverse studies of transgender youths to date, researchers led by a team at The University of Texas at Austin have found that when transgender youths are allowed to use their chosen name in places such as work, school and at home, their risk of depression and suicide drops.     

“Many kids who are transgender have chosen a name that is different than the one that they were given at birth,” said author Stephen T. Russell, professor and chair of human development and family science. “We showed that the more contexts or settings where they were able to use their preferred name, the stronger their mental health was.”

 

New standards of care for trans and gender diverse children and adolescents

The Royal Children’s Hospital Melbourne, 2017

The first Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents, led Led by the Royal Children’s Hospital in Melbourne, have been released.

Dr Michelle Telfer, Head of Adolescent Medicine and Gender Services at the RCH, says health professionals, such as GPs, school counsellors and psychologists, from around the country often seek information from the RCH but until now only international guidelines had been available.

“With 1.2% of adolescents identifying as transgender, and referrals and requests for specialist support on the rise, there is definitely a need for Australia to have its own guidelines. Trans-medicine is a relatively new area of medical practise, and most doctors didn’t get taught how to manage the care of trans children and adolescents in medical school or in their later specialist training. These guidelines, developed by leaders in this field, will help to fill this knowledge gap,” she says.

The guidelines were developed using current evidence and the input of more than 50 specialists, and they have the endorsement of the Australian and New Zealand Professional Association for Transgender Health.

The guidelines include terminology, information about the unique clinical needs, treatment information, and the role of the various medical disciplines involved in the care.

Trans and gender diverse children and teenagers, and their parents, have also been consulted along the way.

“We frequently hear that many doctors, and other clinicians, don’t feel confident in what to do or say when they come across trans or gender diverse children or adolescents for the first time. With a guide to help them through all the stages of their care, our patients’ feel that they are likely to get better care and that others will also have a more positive experience when approaching doctors or psychologists,” she adds.

 

Summary of results: Trans Pathways: the mental health experiences and care pathways of trans young people

Telethon Kids Institute, Perth, September 1, 2017

Trans Pathways is the largest study ever conducted of the mental health and care pathways of trans and gender diverse young people in Australia (859 participants). It is also the first Australian study to incorporate the views of parents and guardians of trans young people (194 participants).

What did Trans Pathways tell us?

  • Trans young people are at very high risk for poor mental health, self-harming and suicide attempts
  • Trans young people found it difficult to access health services
  • Many trans young people have experienced negative situations that affect their mental health such as peer rejection, bullying, issues with school, university or TAFE, and a lack of family support
  • Participants told us they used music and art, peers and friends, activism, social media and pets to make themselves feel better and take care of their mental wellbeing

The authors have provided a list of recommendations for governments and health providers, as well as guidance for schools, parents, peers and young trans people.

Download report:

If you or anyone you know needs help: