HIV testing behaviors and knowledge of HIV reporting regulations among male-to-female transgenders.

Abstract

To the Editor: We recently published our findings from the HIV Testing Survey (HITS),1 a study designed by the Centers for Disease Control and Prevention to assess the potential effect that HIV infection reporting might have on delaying or deterring high-risk persons from seeking HIV testing.2,3 HITS has been conducted among the traditional HIV risk groups of men who have sex with men, injection drug users, and high-risk heterosexuals. Missing from these evaluations have been male-to-female (MTF) transgenders, a population at high risk for HIV infection. Transgenders are persons who are born one sex but identify as either the opposite sex or as transgender. Previous studies have demonstrated high rates of HIV infection and risk behaviors among MTF transgenders, those born male but who later identify as female or transgender.4,5 In San Francisco, previous studies of MTF transgenders have found an HIV prevalence rate of 35%6 and incidence rates of 7.8 per 100 person-years7 and 12.5% per year.8 We conducted a modified version of HITS among MTF transgenders in San Francisco to determine knowledge of HIV reporting regulations and the potential effect that HIV reporting might have on deterring or delaying HIV testing in this population. Females or MTF transgender-appearing persons were recruited from 8 transgender-focused social service agencies, 6 bars, 7 street locations, and 4 community event that were known to be frequented by MTF transgenders between June 26 and October 18, 2002. Persons aged ≥18 years who had resided in California for at least the past 6 months and who were born male but currently identified as female or who identified as transgender currently or at some time in their lives were eligible to participate. Those who provided verbal consent were administered an anonymous face-to-face interview immediately following recruitment or the following day at a nearby agency or the San Francisco Department of Public Health. Participants were compensated $25 for their time. Of a total of 181 eligible persons, 153 (85%) participated. Two were enrolled prior to July 1, 2002, the day that HIV reporting using a non–name code was implemented in California, and were excluded from analysis of knowledge of reporting regulations. Fourteen percent of subjects were white, 37% Latina, 22% African American, and the remainder predominantly Asian and Pacific Islanders. Fifty percent had monthly incomes of ≤$1000. Thirty-four percent were commercial sex workers and 8% sold illicit drugs. Forty-eight percent lacked health insurance. One hundred forty (92%) of the subjects had been HIV tested and 34 (22%) knew they were HIV infected. Among the 13 subjects who had never been tested for HIV infection, 3 noted that fear of having their name reported to the government if they tested positive was one reason they had not tested for HIV infection, but none of these subjects cited this as their most important reason for not testing. Subjects who did not report being HIV infected were presented with several, not mutually exclusive, descriptions of HIV reporting in California. There were 52 participants (44%) who correctly noted that California HIV reporting regulations require reporting using a unique identifier. However, only 5 (4.3%) of subjects were able to correctly identify California HIV reporting system as using a unique identifier reporting and to correctly note that California does not use any of the other HIV reporting systems presented (Table 1).Table 1: HIV Testing and Knowledge of HIV Reporting Regulations Among Male-to-Female Transgenders, San Francisco†Consistent with our prior study,1 HIV testing rates were high and fear of having their name reported to the government was an infrequent reason for not testing. The proportion of participants who correctly answered the reporting system questions was similar in the transgender and traditional HITS, suggesting that knowledge of reporting regulations is limited. Information obtained so far suggests that HIV reporting does not appear to be a substantial deterrent to HIV testing. Sandra Schwarcz, MD, MPH Susan Scheer, PhD, MPH Department of Public Health, San Francisco, CA