A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults

Abstract

There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female (MTF) transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 ‘grey literature’ reports were identified, most in the U.S. or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviors contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardized sexual risk assessment measures, targeted data collection in lower and middle income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviors and engage local FTM communities.

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action

“…In a recent review, estimates of recent condomless vaginal or anal intercourse ranged from 7–69% [18]. The inclusion in many studies of transgender men regardless of the sex of their partners contributes to this variability, as most of their sexual partners are cisgender women [19].…”

“…Condomless vaginal intercourse appears more frequent than condomless anal intercourse among transgender men [19, 22]. While this may contribute to lower HIV risk, transgender men using testosterone therapy may experience vaginal tissue changes (similar to menopausal cisgender women [23]) that may increase susceptibility to HIV infection [18]. …”

Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males

“…Although HIV prevalence in TMSM ranges from 0 to 3% in the small convenience sample studies conducted to date, 1,3-5,11-13 self-reported lifetime STI histories range from 6% to 47%, 3 and current HIV-related sexual risk behaviours from 7% to 69% depending on how risk was operationalised. 3-5 A national study of TMSM ( n = 45) found that only 31% reported “always” using a condom during vaginal sex, 40% reported using a condom “always” during anal sex, and 91% had a previous STI diagnosis.…”

Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009–2014

“…5–7 In the United States, HIV research on transgender men (assigned a female sex at birth) is eclipsed by that on transgender women (assigned a male sex at birth), mainly because estimates of HIV prevalence are higher (25%–31%) among transgender women than among transgender men (0%–3%). 6 However, research suggests that transgender men who have sex with men are at increased risk for HIV acquisition, 8,9 and transgender men constitute 15.4% of the newly diagnosed HIV cases among trans-gender persons. 10 Transgender men are an understudied population lacking evidence-based HIV interventions to address their needs.…”

“…Surveillance systems designed to monitor health outcomes of the general population often lack adequate data about gender identity, making it difficult to distinguish between transgender and cisgender persons. 9 This article is the first to present sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men drawn from a representative sample of adults receiving medical care in the United States.…”