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. 2001 Jun;91(6):915–921. doi: 10.2105/ajph.91.6.915

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

K Clements-Nolle 1, R Marx 1, R Guzman 1, M Katz 1
PMCID: PMC1446468  PMID: 11392934

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.

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Selected References

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  1. Bockting W. O., Robinson B. E., Rosser B. R. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998 Aug;10(4):505–525. doi: 10.1080/09540129850124028. [DOI] [PubMed] [Google Scholar]
  2. Boles J., Elifson K. W. The social organization of transvestite prostitution and AIDS. Soc Sci Med. 1994 Jul;39(1):85–93. doi: 10.1016/0277-9536(94)90168-6. [DOI] [PubMed] [Google Scholar]
  3. Cochran S. D., Mays V. M. Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. Am J Public Health. 2000 Apr;90(4):573–578. doi: 10.2105/ajph.90.4.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cornwall A., Jewkes R. What is participatory research? Soc Sci Med. 1995 Dec;41(12):1667–1676. doi: 10.1016/0277-9536(95)00127-s. [DOI] [PubMed] [Google Scholar]
  5. D'Augelli A. R., Hershberger S. L., Pilkington N. W. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Am J Orthopsychiatry. 1998 Jul;68(3):361–375. doi: 10.1037/h0080345. [DOI] [PubMed] [Google Scholar]
  6. Elifson K. W., Boles J., Posey E., Sweat M., Darrow W., Elsea W. Male transvestite prostitutes and HIV risk. Am J Public Health. 1993 Feb;83(2):260–262. doi: 10.2105/ajph.83.2.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Elifson K. W., Boles J., Sweat M. Risk factors associated with HIV infection among male prostitutes. Am J Public Health. 1993 Jan;83(1):79–83. doi: 10.2105/ajph.83.1.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Galli M., Esposito R., Antinori S., Cernuschi M., Moroni M., Giannelli F., Cargnel A., Quirino T., Innocenti M., Marozzi F. HIV-1 infection, tuberculosis, and syphilis in male transsexual prostitutes in Milan, Italy. J Acquir Immune Defic Syndr. 1991;4(10):1006–1007. [PubMed] [Google Scholar]
  9. Gallo D., George J. R., Fitchen J. H., Goldstein A. S., Hindahl M. S. Evaluation of a system using oral mucosal transudate for HIV-1 antibody screening and confirmatory testing. OraSure HIV Clinical Trials Group. JAMA. 1997 Jan 15;277(3):254–258. [PubMed] [Google Scholar]
  10. Garofalo R., Wolf R. C., Wissow L. S., Woods E. R., Goodman E. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999 May;153(5):487–493. doi: 10.1001/archpedi.153.5.487. [DOI] [PubMed] [Google Scholar]
  11. Kral A. H., Lorvick J., Edlin B. R. Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. J Acquir Immune Defic Syndr. 2000 Jun 1;24(2):162–167. doi: 10.1097/00126334-200006010-00011. [DOI] [PubMed] [Google Scholar]
  12. Lemp G. F., Hirozawa A. M., Givertz D., Nieri G. N., Anderson L., Lindegren M. L., Janssen R. S., Katz M. Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men. The San Francisco/Berkeley Young Men's Survey. JAMA. 1994 Aug 10;272(6):449–454. [PubMed] [Google Scholar]
  13. Leonard T., Sacks J. J., Franks A. L., Sikes R. K. The prevalence of human immunodeficiency virus, hepatitis B, and syphilis among female prostitutes in Atlanta. J Med Assoc Ga. 1988 Mar;77(3):162-4, 167. [PubMed] [Google Scholar]
  14. Mansergh G., Marks G. Age and risk of HIV infection in men who have sex with men. AIDS. 1998 Jul 9;12(10):1119–1128. doi: 10.1097/00002030-199810000-00003. [DOI] [PubMed] [Google Scholar]
  15. Modan B., Goldschmidt R., Rubinstein E., Vonsover A., Zinn M., Golan R., Chetrit A., Gottlieb-Stematzky T. Prevalence of HIV antibodies in transsexual and female prostitutes. Am J Public Health. 1992 Apr;82(4):590–592. doi: 10.2105/ajph.82.4.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moriarty H. J., Thiagalingam A., Hill P. D. Audit of service to a minority client group: male to female transsexuals. Int J STD AIDS. 1998 Apr;9(4):238–240. doi: 10.1258/0956462981921981. [DOI] [PubMed] [Google Scholar]
  17. Moss A. R., Vranizan K., Gorter R., Bacchetti P., Watters J., Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS. 1994 Feb;8(2):223–231. doi: 10.1097/00002030-199402000-00010. [DOI] [PubMed] [Google Scholar]
  18. Mulrow C. D., Williams J. W., Jr, Gerety M. B., Ramirez G., Montiel O. M., Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995 Jun 15;122(12):913–921. doi: 10.7326/0003-4819-122-12-199506150-00004. [DOI] [PubMed] [Google Scholar]
  19. Nemoto T., Luke D., Mamo L., Ching A., Patria J. HIV risk behaviours among male-to-female transgenders in comparison with homosexual or bisexual males and heterosexual females. AIDS Care. 1999 Jun;11(3):297–312. doi: 10.1080/09540129947938. [DOI] [PubMed] [Google Scholar]
  20. Osmond D. H., Page K., Wiley J., Garrett K., Sheppard H. W., Moss A. R., Schrager L., Winkelstein W. HIV infection in homosexual and bisexual men 18 to 29 years of age: the San Francisco Young Men's Health Study. Am J Public Health. 1994 Dec;84(12):1933–1937. doi: 10.2105/ajph.84.12.1933. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pang H., Pugh K., Catalan J. Gender identity disorder and HIV disease. Int J STD AIDS. 1994 Mar-Apr;5(2):130–132. doi: 10.1177/095646249400500210. [DOI] [PubMed] [Google Scholar]
  22. Schwab M., Syme S. L. On paradigms, community participation, and the future of public health. Am J Public Health. 1997 Dec;87(12):2049–2052. doi: 10.2105/ajph.87.12.2049. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Spizzichino L., Casella P., Zaccarelli M., Rezza G., Venezia S., Gattari P. HIV infection among foreign people involved in HIV-related risk activities and attending an HIV reference centre in Rome: the possible role of counselling in reducing risk behaviour. AIDS Care. 1998 Aug;10(4):473–480. doi: 10.1080/09540129850124000. [DOI] [PubMed] [Google Scholar]
  24. Stephens T., Cozza S., Braithwaite R. L. Transsexual orientation in HIV risk behaviours in an adult male prison. Int J STD AIDS. 1999 Jan;10(1):28–31. doi: 10.1258/0956462991913042. [DOI] [PubMed] [Google Scholar]
  25. Tirelli U., Vaccher E., Bullian P., Saracchini S., Errante D., Bullian P., Zagonel V., Serraino D. HIV-1 seroprevalence in male prostitutes in northeast Italy. J Acquir Immune Defic Syndr. 1988;1(4):414–415. [PubMed] [Google Scholar]
  26. Tirelli U., Vaccher E., Covre P., Corso C., Serraino D., Rezza G. Condom use among transvestites in Italy. J Acquir Immune Defic Syndr. 1991;4(3):302–303. [PubMed] [Google Scholar]
  27. Tirelli V., Rezza G., Giuliani M., Caprilli F., Gentili G., Lazzarin A., Saracco A., DeMercato R. HIV seroprevalence among 304 female prostitutes from four Italian towns. AIDS. 1989 Aug;3(8):547–548. doi: 10.1097/00002030-198908000-00015. [DOI] [PubMed] [Google Scholar]
  28. Valenta L. J., Elias A. N., Domurat E. S. Hormone pattern in pharmacologically feminized male transsexuals in the California State prison system. J Natl Med Assoc. 1992 Mar;84(3):241–250. [PMC free article] [PubMed] [Google Scholar]
  29. Waldo C. R., Hesson-McInnis M. S., D'Augelli A. R. Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: a structural model comparing rural university and urban samples. Am J Community Psychol. 1998 Apr;26(2):307–334. doi: 10.1023/a:1022184704174. [DOI] [PubMed] [Google Scholar]
  30. Watters J. K., Bluthenthal R. N., Kral A. H. HIV seroprevalence in injection drug users. JAMA. 1995 Apr 19;273(15):1178–1178. [PubMed] [Google Scholar]
  31. Watters J. K., Estilo M. J., Clark G. L., Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994 Jan 12;271(2):115–120. [PubMed] [Google Scholar]
  32. Watters J. K. Trends in risk behavior and HIV seroprevalence in heterosexual injection drug users in San Francisco, 1986-1992. J Acquir Immune Defic Syndr. 1994 Dec;7(12):1276–1281. [PubMed] [Google Scholar]
  33. Weissman M. M., Bland R. C., Canino G. J., Greenwald S., Hwu H. G., Joyce P. R., Karam E. G., Lee C. K., Lellouch J., Lepine J. P. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999 Jan;29(1):9–17. doi: 10.1017/s0033291798007867. [DOI] [PubMed] [Google Scholar]
  34. Weissman M. M., Sholomskas D., Pottenger M., Prusoff B. A., Locke B. Z. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol. 1977 Sep;106(3):203–214. doi: 10.1093/oxfordjournals.aje.a112455. [DOI] [PubMed] [Google Scholar]
  35. Wilson M. J., Marelich W. D., Lemp G. F., Ascher M. S., Kerndt P., Kizer K. W. HIV-1 seroprevalence among women attending sexually transmitted disease clinics in California. California Family of Surveys and Sentinel Surveillance Consortia. West J Med. 1993 Jan;158(1):40–43. [PMC free article] [PubMed] [Google Scholar]
  36. van Kesteren P. J., Asscheman H., Megens J. A., Gooren L. J. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf) 1997 Sep;47(3):337–342. doi: 10.1046/j.1365-2265.1997.2601068.x. [DOI] [PubMed] [Google Scholar]

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