Abstract
BackgroundStudies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity.MethodsThe Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups.ResultsTrans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions – 25% of female-to-male (FTM) and 51% of MTF individuals – had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible.ConclusionsResults suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.
Highlights
Studies of Human immunodeficiency virus (HIV)-related risk in trans people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum
Previous reports on the health of trans people suggest this community is disproportionately affected by HIV and other sexually transmitted infections [1,2,3,4,5]
An estimated 49% of trans people earned less than $15,000 per year, and 34% lived in poverty, with household income that fell below the Statistics Canada low-income cut-off based on household size
Summary
Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Previous reports on the health of trans (transgender, transsexual or transitioned; see Table 1 for definitions) people suggest this community is disproportionately affected by HIV and other sexually transmitted infections [1,2,3,4,5]. Genderqueer persons refers to people whose gender identities fall outside of the normative and binary female or male. Social transition status the extent to which one has changed the gender in which they live their day-to-day life to better align with their core gender; may involve changing a name, using a new pronoun, and/or changing gender-specific aspects of one’s social presentation
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