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HIV in Transgender Populations: Charted and Uncharted Waters
Tonia C. Poteat,Johns Hopkins Univ, Baltimore, MD, USA
A growing body of research has demonstrated the heavy and disproportionate burden of HIV among transgender populations around the world. Transgender women, in particular, face an estimated global HIV prevalence of 19% with 49 times the odds of infection compared to the general adult population. Research among transgender men is quite limited with prevalence estimates that range from 0 - 10%. Estimates of the absolute number of transgender people living with HIV are lacking; however, recent data suggest they make up a key minority of HIV-infected adults in care.
This presentation will focus on what is known and not known about HIV and its drivers among transgender populations. Access to and utilization of exogenous hormone therapy and its impact on HIV risk as well as clinical implications for antiretroviral therapy will be discussed. What is known about the impact of genital reconstruction on HIV acquisition and transmission will be reviewed. We will examine the widespread use of illicit soft tissue fillers for body modification and their potential consequences for HIV disease progression. Relationships between stigma, sex work, and co-occurring syndemics of depression, victimization, substance use, and HIV will be described.
Modeling data suggest the need for combination high-impact prevention in order to significantly reduce HIV incidence in this population. Uptake of and adherence to PrEP has been limited by community concerns about potential drug-drug interactions between ART and hormone therapy; and preliminary unpublished data suggest associations between ART adherence and co-location of gender-related care with HIV services.
Current NIH-funded studies include behavioral, self-testing, PrEP adherence, and telemedicine interventions. However, more research is needed. Data on HIV prevalence in transgender populations is missing from the African continent as well as Eastern Europe/Central Asia. Little is known about the sexual partnerships and networks of transgender people; nor is there data on co-morbidities and co-infections among HIV-infected transgender people taking exogenous hormones. Implementation science studies are needed to inform how best to implement and scale up multi-component, high impact, prevention care and treatment interventions that address structural drivers, reduce HIV incidence, and improve the health and longevity of transgender people living with HIV.