High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey

Abstract

BackgroundStudies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity.MethodsThe Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups.ResultsTrans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions – 25% of female-to-male (FTM) and 51% of MTF individuals – had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible.ConclusionsResults suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

“…Some FTM patients may undergo either total or supracervical hysterectomy, usually without oophorectomy; patients do not always know which anatomical structures were removed during surgical procedures. [11][12][13][14][15] Some FTM patients choose to have "lower" genital reconstructive surgery (e.g., metoidioplasty, phalloplasty); however, most do not. 14,16,17 Both patients and providers in our interviews expressed misperceptions about HPV and cervical cancer risks (Table 2).…”

“…14,16,17 Both patients and providers in our interviews expressed misperceptions about HPV and cervical cancer risks (Table 2). FTM patients are at risk for sexually transmitted infections (STIs), including HPV, due to retention of the uterine cervix 18 and sexual exposure 15,19,20 in the majority of people in this population. Professional guidelines for routine cervical cancer and STI screenings in this population are identical to those recommended for cisgender women.…”

Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening

“…The majority of FTMs either do not undergo complete sex reassignment surgery or undergo total hysterectomy later in life, and therefore have a cervix for a substantial portion of their lives. 1 Therefore, cancers of natal reproductive organs, including the cervix, can still occur and have been documented. 2 The American College of Obstetricians and Gynecologists (ACOG) recommends that transgender men with a cervix follow the same screening guidelines as non-transgender females.…”

A systematic review of HIV testing among Canadian populations

“…Out of the total number of survey respondents, 20% of transgender people reported testing in the previous year and 67.1% of female sex workers reported recent testing with no timeline indicated (Table 3). 29 …”

“…Bauer, 2012 29 Deering, 2012 31 Ghai, 2008 38 Gray, 2008 32 Mairs, 2010 37 Peterman, 2008 36 Raffa, 2010 30 Schwandt, 2011 34 Vibert, 2010 33 Wagner Non-probability sampling (not specified) Non-probability sampling Non-probability (venue-based and snowball) Non-probability sampling Non-probability sampling Non-probability sampling (venue-based, word-of mouth) Non-probability sampling Non-probability sampling (venue-based) Non-probability sampling limitations and gaps were uncovered, including a lack of research on certain specific populations and a lack of information on testing frequency and recent testing. Most studies relied on self-reported health behaviour information which is subject to social desirability response bias.…”