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      Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People.

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          Abstract

          Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations.

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          Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

          Judith Bradford, Sari Reisner, Julie Honnold … (2013)
          We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
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            Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.

            Wylie Hembree, Peggy Cohen-Kettenis, Henriette Delemarre-van de Waal … (2009)
            The aim was to formulate practice guidelines for endocrine treatment of transsexual persons. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low. Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and World Professional Association for Transgender Health commented on preliminary drafts of these guidelines. Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person's genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person's desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons.
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              Gender Affirmation: A Framework for Conceptualizing Risk Behavior among Transgender Women of Color.

              Jae Sevelius (2013)
              Experiences of stigma, discrimination, and violence as well as extreme health disparities and high rates of sexual risk behavior and substance use have been well-documented among transgender women of color. Using an intersectional approach and integrating prominent theories from stigma, eating disorders, and HIV-related research, this article offers a new framework for conceptualizing risk behavior among transgender women of color, specifically sexual risk behavior and risky body modification practices. This framework is centered on the concept of 'gender affirmation,' the process by which individuals are affirmed in their gender identity through social interactions. Qualitative data from 22 interviews with transgender women of color from the San Francisco Bay Area in the United States are analyzed and discussed in the context of the gender affirmation framework.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): J. Acquir. Immune Defic. Syndr.
                Title: Journal of acquired immune deficiency syndromes (1999)
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Electronic): 1944-7884
                ISSN (Print): 1525-4135
                Publication date (Electronic): Aug 15 2016
                Volume: 72 Suppl 3
                Affiliations
                [1 ] *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Epidemiology and Biostatistics, Western University, London, Canada; ‡U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland; and §Boston Children's Hospital/Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA.
                Article
                Publisher Item ID: 00126334-201608151-00002
                DOI: 10.1097/QAI.0000000000001087
                PMC ID: 4969059
                PubMed ID: 27429185
                SO-VID: 3106362c-604f-446f-99bd-d4c0eccddc93
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