Title Risk behavior and sexually transmitted infections among transgender women and men undergoing community-based screening for acute and early HIV infection in San Diego Permalink

The transgender community represents an understudied population in the literature. The objective of this study was to compare risk behavior, and HIV and sexually transmitted infection (STI) rates between transgender women and transgender men undergoing community-based HIV testing. With this retrospective analysis of a cohort study, we characterize HIV infection rates as well as reported risk behaviors and reported STI in 151 individual transgender women and 30 individual transgender men undergoing community based, voluntary screening for acute and early HIV infection (AEH) in San Diego, California between April 2008 and July 2014. HIV positivity rate was low for both, transgender women and transgender men undergoing AEH screening (2% and 3%, respectively), and the self-reported STI rate for the prior 12 months was 13% for both. Although transgender women appeared to engage in higher rates of risk behavior overall, with 69% engaged in condomless receptive anal intercourse (CRAI) and 11% engaged in sex work, it is important to note that 91% of transgender women reported recent sexual intercourse, 73% had more than 1 sexual partner, 63% reported intercourse with males, 37% intercourse with males and females, and 30% had CRAI. don Morris, MD, and Susan J. Little, MD support the need for comprehensive HIV prevention in both, transgender women and men. (Medicine 94(41):e1830) Abbreviations: AEH = acute and early HIV infection, CDC = Center of Disease Control and Prevention, CRAI = condomless receptive anal intercourse, IQR = inter-quartile range, MSM = men who have sex with men, STI = sexually transmitted infections. INTRODUCTION T ransgender women are considered to be one of the highest risk groups for HIV infection. In a recent meta-analysis, the pooled HIV prevalence was 19.1% in transgender women worldwide (n1⁄4 11,066), and 21.7% for transgender women in the United States (n1⁄4 2705, from 9 studies). In another meta-analysis, large percentages of transgender women (range 27%–48%) reported engaging in risky behaviors, such as condomless receptive anal intercourse (CRAI), multiple casual partners, or sex work. Notably, however, risk behavior and HIV prevalence data varied widely between studies. Also HIV prevalence has been 11.8%, and therefore markedly lower in 18 other studies focusing on self-reported HIV seropositivity among transgender women. To date, very few studies evaluated HIV prevalence and risk behaviors among transgender men. Most of these studies reported that both, HIV prevalence rates (range 0–3%) and risk behaviors were low among transgender men. In contrast, similar HIV prevalence rates (about 10%), risk behavior, and sexually transmitted infection (STI) rates in transgender men when compared to transgender women were reported in a more recent study. The objective of this study was to compare risk behavior, HIV, and STI rates between transgender women and transgender men undergoing community-based HIV testing with detection of acute and early HIV infection (AEH).