transgender women

Six innovative models for PrEP services

Author
Roger Pebody

For pre-exposure prophylaxis (PrEP) to have a substantial public health impact, access to PrEP needs to be improved so that more people who would benefit from it receive PrEP. Services need to adapt and innovate. A series of recent articles, most of them published in a special issue of Sexual Health, outline a range of promising approaches.

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The global response and unmet actions for HIV and sex workers

Author
Kate Shannon, Anna-Louise Crago, Stefan D Baral, Linda-Gail Bekker, Deanna Kerrigan, Michele R Decker, Tonia Poteat, Andrea L Wirtz, Brian Weir, Marie-Claude Boily, Jenny Butler, Steffanie A Strathdee, Chris Beyrer

Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5–11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women.

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HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

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Yes
Author
Tonia Poteat, Benjamin Ackerman, Daouda Diouf, Nuha Ceesay, Tampose Mothopeng, Ky-Zerbo Odette, Seni Kouanda, Henri Gautier Ouedraogo, Anato Simplice, Abo Kouame, Zandile Mnisi, Gift Trapence, L. Leigh Ann van der Merwe, Vicente Jumbe, Stefan Baral

Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.

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Project Gel a Randomized Rectal Microbicide Safety and Acceptability Study in Young Men and Transgender Women

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Yes
Author
McGowan I, Cranston RD, Mayer KH, Febo I, Duffill K, Siegel A, et al.

The purpose of Project Gel was to determine the safety and acceptability of rectal microbicides in young men who have sex with men (MSM) and transgender women (TGW) at risk of HIV infection.

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JAIDS Supplement: HIV Prevention of Transgender Populations

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Yes
Author
Journal of Acquired Immune Deficiency Syndromes (JAIDS)

Transgender people have been disproportionally affected by HIV, particularly transgender women. Their increased vulnerability to HIV is due to multiple issues, including biological (eg, increased efficiency of HIV transmission through receptive anal sex), epidemiological (eg, increased likelihood of having HIV-infected partners), structural (eg, social stigma limiting employment options), and individual factors (eg, internalized stigma leading to depression and substance use and risk-taking behaviors).

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Depression and Oral FTC/TDF Pre-exposure Prophylaxis (PrEP) Among Men and Transgender Women Who Have Sex With Men (MSM/TGW)

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Yes
Author
Patricia A. Defechereux, Megha Mehrotra, Albert Y. Liu, Vanessa M. McMahan, David V. Glidden, Kenneth H. Mayer, Lorena Vargas, K. Rivet Amico, Piotr Chodacki, Telmo Fernandez, Vivian I. Avelino-Silva, David Burns, Robert M. Grant

We conducted a longitudinal and cross-sectional analysis of depressive symptomology in iPrEx, a randomized, placebo-controlled trial of daily, oral FTC/TDF HIV pre-exposure prophylaxis (PrEP) in men and transgender women who have sex with men. Depression-related adverse events (AEs) were the most frequently reported severe or life-threatening AEs and were not associated with being randomized to the FTC/TDF arm (152 vs. 144 respectively OR 0.66 95 % CI 0.35–1.25).

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Transgender people are at high risk for HIV, but too little is known about prevention and treatment for this population

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Yes
Author
Liz Highleyman

Transgender women have among the highest rates of HIV infection but little is known about HIV prevalence among trans men, Tonia Poteat of Johns Hopkins Bloomberg School of Public Health said in a plenary lecture on transgender health and HIV at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston – the first ever on this population at CROI. A growing number of studies and prevention and treatment programmes are addressing transgender populations, but more research is needed.

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HIV risk and preventive interventions in transgender women sex workers

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Yes
Author
Dr Tonia Poteat, PhDl, Andrea L Wirtz, MHS, Anita Radix, MD, Annick Borquez, PhD, Alfonso Silva-Santisteban, MD, Madeline B Deutsch, MD, Sharful Islam Khan, PhD, Sam Winter, PhD, Don Operario, PhD

Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions.

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