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      Opportunities and Gaps in Primary Care Preventative Health Services for Transgender Patients: A Systemic Review

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          Abstract

          Purpose: Transgender people face barriers to accessing healthcare, resulting in population-level disparities in health outcomes. Little research is available to better understand the receipt of primary healthcare among transgender patients or how the rate of receipt of preventive care may differ among transgender populations.

          Methods: The medical literature regarding U.S. adult transgender primary healthcare was reviewed using a keyword search strategy: transgender OR transsexual OR transvestite OR gender nonconforming for articles published between January 1, 2001 and June 15, 2015. Studies addressing the following topics as assessed by the Behavioral Risk Factor Surveillance System were extracted for qualitative review: colorectal cancer screenings, mammography or chest/breast tissue examinations, cholesterol and blood pressure screenings, tobacco use and smoking cessation, cervical cancer or human papillomavirus (HPV) screenings, human immunodeficiency virus (HIV), annual flu shot, and insurance coverage.

          Results: The search identified 1304 eligible records, of which 41 discussed transgender primary or preventive care. The majority of studies discussed HIV rates or risk behaviors, while fewer articles addressed pelvic examinations, tobacco use, insurance coverage, and cholesterol screenings. No studies addressed mammography or chest/breast tissue examinations, colorectal screenings, or flu shots.

          Conclusions: Findings from articles addressing five topics are discussed: HIV, cholesterol screenings, tobacco use, pelvic health, and insurance coverage. Gaps in the extant literature, including the lack of studies of nonbinary people, transgender men of color, and transgender people living outside of large coastal urban centers, are discussed. This review, coincident with other health disparity findings, suggests an urgent need for research that addresses the primary care needs of all transgender and gender nonconforming people.

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          Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

          Kate E. Coleman, W Bockting, M. Botzer … (2012)
          Article 0 comments Cited 725 times – based on 0 reviews     Review now
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            Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.

            R Gray, M Wawer, R Brookmeyer … (2001)
            The probability of HIV-1 transmission per coital act in representative African populations is unknown. We aimed to calculate this probability overall, and to estimate how it is affected by various factors thought to influence infectivity. 174 monogamous couples, in which one partner was HIV-1 positive, were retrospectively identified from a population cohort in Rakai, Uganda. Frequency of intercourse and reliability of reporting within couples was assessed prospectively. HIV-1 seroconversion was determined in the uninfected partners, and HIV-1 viral load was measured in the infected partners. Adjusted rate ratios of transmission per coital act were estimated by Poisson regression. Probabilities of transmission per act were estimated by log-log binomial regression for quartiles of age and HIV-1 viral load, and for symptoms or diagnoses of sexually transmitted diseases (STDs) in the HIV-1-infected partners. The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner. Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.
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              HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

              K Clements-Nolle, R Marx, R. Guzman … (2001)
              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. 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. 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. 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.
              Article 0 comments Cited 224 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transgend Health
                Journal ID (iso-abbrev): Transgend Health
                Journal ID (publisher-id): trgh
                Title: Transgender Health
                Publisher: Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Electronic): 2380-193X
                Publication date (Electronic): 01 November 2016
                Publication date Collection: 2016
                Publication date PMC-release: 01 November 2016
                Volume: 1
                Issue: 1
                Pages: 216-230
                Affiliations
                [ 1 ]Vanderbilt Program for LGBTI Health , Nashville, Tennessee.
                [ 2 ]Columbia University Program in Narrative Medicine , New York, New York.
                [ 3 ]University of California San Francisco School of Medicine , San Francisco, California.
                [ 4 ]Department of Dermatology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
                [ 5 ]Vanderbilt University Medical Center , Nashville, Tennessee.
                [ 6 ]Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania.
                Author notes

                Portions of this work were presented at the GLMA Annual Meeting in 2014.

                [*] [ * ]Address correspondence to: E. Kale Edmiston, PhD, Vanderbilt Program for LGBTI Health, 319 Light Hall, 1161 21st Avenue South, Nashville, TN 37232, E-mail: ekale513@ 123456gmail.com
                Article
                Publisher ID: 10.1089/trgh.2016.0019
                DOI: 10.1089/trgh.2016.0019
                PMC ID: 5367473
                PubMed ID: 28861536
                SO-VID: 8f69f2ed-8103-46ce-9cb7-f628096c8ff3
                Copyright © © E. Kale Edmiston et al. 2016; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                Page count
                Figures: 1, Tables: 5, References: 82, Pages: 15
                Categories
                Subject: Review Article

                Keywords: hiv,primary care,sexual health,transgender
                Data availability:
                Keywords: hiv, primary care, sexual health, transgender

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