HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention

TLDR

The study aimed to describe HIV prevalence, risk behaviors, health care use, and mental health status among male‑to‑female and female‑to‑male transgender persons and identify factors associated with HIV. The authors recruited 392 male‑to‑female and 123 female‑to‑male transgender individuals via targeted sampling, respondent‑driven sampling, and agency referrals, interviewing and testing them for HIV. HIV prevalence was 35 % among male‑to‑female transgender persons and 2 % among female‑to‑male, with African American race, injection drug use, multiple partners, and low education independently associated with infection; 62 % of male‑to‑female and 55 % of female‑to‑male participants were depressed, 32 % had attempted suicide, and most had recent medical contact, underscoring an urgent need for risk‑reduction interventions and the potential role of providers in linking to services.

Abstract

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.