Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review

Gerwen, Olivia T Van; Jani, Aditi; Long, Dustin; Austin, Erika L.; Musgrove, Karen; Muzny, Christina A

doi:10.1089/trgh.2019.0053

Cited by 86 publications

(86 citation statements)

References 70 publications

(95 reference statements)

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“…A growing body of research has documented a disproportionately high burden of adverse health outcomes among transgender women, including human immunodeficiency virus (HIV), sexually transmitted infections (STIs), depression, and substance misuse. [1][2][3][4][5][6] One meta-analysis estimated the worldwide prevalence of HIV among transgender women at 19% and found a 49-fold increase in the odds of HIV infection compared with non-transgender adults of reproductive age. 7 Despite these disparities, HIV/STI research has historically grouped transgender women with men who have sex with men (MSM) or excluded them from studies altogether.…”

Section: Introductionmentioning

confidence: 99%

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

et al. 2021

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There is a need for ongoing behavioral surveillance of human immunodeficiency virus (HIV)/sexually transmitted infection (STI) risk among transgender women, using assessments adapted to this population. We therefore developed and piloted the Transgender Women's Internet Survey and Testing (TWIST) study, a cross-sectional behavioral survey of transgender women in the United States coupled with remote biospecimen collection and testing. Methods: Participants age 15 + were recruited by using social media advertisements. Participants were eligible to take the survey if they reported male sex at birth, identified as female or as a transgender woman, resided in the United States, and reported ever having oral, vaginal, or anal sex. We examined a number of behavioral indicators by age, county population density, and medical gender affirmation treatment, using multivariable regression modeling. A sample of respondents was invited to receive a home biospecimen collection kit for HIV/ STI testing. Results: The 401 participants were mainly non-Hispanic white and younger than 25 years. Self-reported HIV prevalence was 1.3% (5/401), and almost half (47.1%, 189/401) did not know their HIV status. Receiving medical gender affirmation was strongly associated with past-year HIV and STI testing, independent of general health care engagement. Of the 155 participants invited to receive home biospecimen collection kits, 48 (31.0%) consented and of those, 21 (43.8%) returned specimens for testing. Conclusion: This pilot study successfully reached its recruitment target and generated useful behavioral measures from an online sample of transgender women. We anticipate that online recruitment combined with selfcollection of biospecimens will serve as an innovative and scalable strategy for ongoing monitoring of HIV/STI behavioral trends among U.S. transgender women.

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Section: Introductionmentioning

confidence: 99%

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

et al. 2021

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“…[13] Though studies of STI prevalence among transgender women have been limited in number and scope and have primarily focused on urogenital detection, a 2020 meta-analysis found estimated STI prevalence rates in transgender women ranging from 2.1%-19.1% for gonorrhea and 2.7%-24.7% for chlamydia. [14] Barriers to chlamydia and gonorrhea rectal screening include increased visit complexity and time compared to urogenital testing; lack of provider awareness regarding need for extra-genital screening; stigma experienced or perceived by patients and/or providers related to sexual behavior; and discomfort with taking or providing a detailed sexual risk assessment and with the collection of rectal samples. [7] Self-collection of extra-genital samples for STI screening is one potential method of overcoming these barriers.…”

Section: Introductionmentioning

confidence: 99%

Rectal Specimen Self-Collection for Chlamydia and Gonorrhea Screening: A Cross-Sectional Pilot Feasibility Study at a Community Health Center

Haddad

Bifulco

McIntosh

et al. 2021

Preprint

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Purpose: Rectal self-collection increases detection of asymptomatic chlamydia and gonorrhea among at-risk men who have sex with men and transgender women. This feasibility study assessed patient and primary care provider (PCP) perceptions of implementing rectal self-collection at a large, general practice community health center.Methods: PCPs offered rectal self-collection to at-risk patients due for routine or risk-based screening. Patients and PCPs completed brief cross-sectional assessments.Results: Rectal screening was feasible in a large primary care setting despite clinical time and resource constraints and was universally accepted when offered (n=36; 91.6% of whom opted for self-collection). Both PCPs and patients preferred self-collection over clinician-collection.Conclusions: Rectal self-collection can increase screening and improve extra-genital chlamydia and gonorrhea diagnoses. Adoption of rectal self-collection in primary care is a scalable, useful, and acceptable strategy to increase extra-genital screening among medically underserved sexual and gender minority patients and combat the current sexually-transmitted infection epidemic.

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“…MSM also face increased incidence of other STIs compared to men and women who have sex with women only [ 3 ]. A recent systematic review reported a high prevalence of other STIs among transgender women but noted that most of the studies were focused on sex workers and may not be representative of the larger population of transgender women [ 4 ]. MSM and transgender women populations generally are at increased risk of developing substance use disorders (SUDs) [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial

Edwards¹,

Reback²,

Cunningham³

et al. 2020

JMIR Res Protoc

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Background Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. Objective The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. Methods A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. Results Enrollment began in November 2019 and study completion is expected in 2023. Conclusions This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. Trial Registration ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 International Registered Report Identifier (IRRID) PRR1-10.2196/18106

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Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review

Cited by 86 publications

References 70 publications

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

Rectal Specimen Self-Collection for Chlamydia and Gonorrhea Screening: A Cross-Sectional Pilot Feasibility Study at a Community Health Center

Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial

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