Descriptive Epidemiology of Factors Associated with Human Immunodeficiency Virus Infections among Men and Transgender Women Who Have Sex with Men in South India

PURPOSE:

Men and transgender women who have sex with men (MTWSM) continue to be an at-risk population for human immunodeficiency virus (HIV) infection in India. Identification of risk factors and determinants of HIV infection is urgently needed to inform prevention and intervention programming.

METHODS:

Data were collected from cross-sectional biological and behavioral surveys from four districts in Karnataka, India. Multivariable logistic regression models were constructed to examine factors related to HIV infection. Sociodemographic, sexual history, sex work history, condom practices, and substance use covariates were included in regression models.

RESULTS:

A total of 456 participants were included; HIV prevalence was 12.4%, with the highest prevalence (26%) among MTWSM from Bellary District. In bivariate analyses, district (P = 0.002), lack of a current regular female partner (P = 0.022), and reported consumption of an alcoholic drink in the last month (P = 0.004) were associated with HIV infection. In multivariable models, only alcohol use remained statistically significant (adjusted odds ratios: 2.6, 95% confidence intervals: 1.2-5.8; P = 0.02).

CONCLUSION:

The prevalence of HIV continues to be high among MTWSM, with the highest prevalence found in Bellary district.

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By:  Shaw SY1, Lorway R1, Bhattacharjee P2, Reza-Paul S1, duPlessis E1, McKinnon L3,4, Thompson LH1, Isac S2, Ramesh BM2, Washington R2,5, Moses S1,6,Blanchard JF1

• 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada .
• 2 Karnataka Health Promotion Trust , Bangalore, India .
• 3 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
• 4 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya .
• 5 St. John's Research Institute , Bangalore, India .
• 6 Department of Medical Microbiology, University of Manitoba , Winnipeg, Manitoba, Canada .
• LGBT Health. 2016 Apr 8. [ 

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'HIV and work don't go together': Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. 

We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n = 16) and transgender women (n = 5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. 

We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.

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By:  Barrington C1, Acevedo R2, Donastorg Y3, Perez M3, Kerrigan D4.

• 1 Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• 2 Consejo Nacional para el VIH y el SIDA , Santo Domingo , Dominican Republic.
• 3 HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugía de Piel Dr. Huberto Bogaert Díaz , Santo Domingo , Dominican Republic.
• 4 Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA. 
• Glob Public Health. 2016 Mar 21:1-16. 

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How a Trans Woman Found Refuge in Pakistan's Progressive Fashion World

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Breast Cancer in a Male to Female Transsexual Patient with a BRCA2 Mutation

Breast cancer is rare in male patients. Certain predisposing factors, be they genetic (e.g. BRCA2 gene mutations) or hormonal (imbalance between estrogen and androgen levels) have been implicated in male breast cancer pathophysiology. 

Male to female (MtF) transsexualism is a condition that generally involves cross-sex hormone therapy. Anti-androgens and estrogens are used to mimic the female hormonal environment and induce the cross-sex secondary characteristics. In certain situations, the change of the hormonal milieu can be disadvantageous and favor the development of hormone-dependent pathologies, such as cancer. 

We report a case of a MtF transgender (TG) patient who developed breast cancer after seven years of cross-sex hormonal therapy. The patient was found to be BRCA2 positive, and suffered recurrent disease. The patient was unaware of being a member of an established BRCA2 mutation positive kindred. 

This represents the first case of a BRCA2 mutation predisposing to breast cancer in a MtF transgender patient.

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By:  Corman V1, Potorac I2, Manto F3, Dassy S4, Segers K5, Thiry A6, Bours V7, Daly AF8, Beckers A9.

• 1V Corman, Department of Endocrinology, CHU de Liege, Liege, Belgium.
• 2I Potorac, Department of Endocrinology, CHU de Liege, Liege, 4000, Belgium.
• 3F Manto, Faculty of Medicine, University of Liege, Liege, Belgium.
• 4S Dassy, Department of Oncology, St. Nikolaus-Hospital, Eupen, Belgium.
• 5K Segers, Department of Human Genetics, CHU de Liege, University of Liege, Liege, Belgium.
• 6A Thiry, Department of Anatomo-pathology, CHU de Liege, Liege, Belgium.
• 7V Bours, Department of Human Genetics, CHU de Liege, University of Liege, Liege, Belgium.
• 8A Daly, Department of Endocrinology, University of Liège, Liège, Belgium.
• 9A Beckers, Department of Endocrinology, Domaine Universitaire du Sart-Tilman, CHU de Liege, Liege, Belgium albert.beckers@chu.ulg.ac.be.
• Endocr Relat Cancer. 2016 Mar 21. pii: ERC-16-0057

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Symptomatic HPV-Related Neovaginal Lesions in Transgender Women: Case Series & Review of Literature

OBJECTIVE:

Worldwide, transgender women are an at-risk population for contracting sexually transmitted infections. Little information exists on symptoms and characteristics of neovaginal human papillomavirus (HPV) infections and associated diseases. We describe a case series of transgender women with symptomatic HPV-related neovaginal lesions and a review of current literature.

METHODS:

Transgender women with symptomatic HPV-related neovaginal lesions were identified from a departmental database comprising clinical and outpatient data on transgender women who underwent vaginoplasty between 1990 and 2015. HPV status was determined on excision and biopsy specimens by HPV DNA testing using GP5+6+-PCR and p16^INK4A immunohistochemistry. Current literature was reviewed using the MEDLINE and EMBASE databases.

RESULTS:

This case series includes four transgender women with symptomatic, HPV-related neovaginal lesions. Two women presented with neovaginal and neovulvar pain and condylomata/leukoplakia, which were excised. These lesions showed moderate-to-severe dysplasia at histopathological examination, and were positive for high-risk HPV (hrHPV) and p16^INK4A. Recurrence occurred in one patient and was treated with laser evaporation. Two women presented with neovaginal coital pain, neovaginal bleeding and condylomata. Neovulvar lesions were treated with podophyllotoxin. Neovaginal lesions were excised or evaporated. These lesions were low-risk HPV (lrHPV) positive. The literature search shows treatment options varying from conservative, topical podophyllotoxin to excision or laser evaporation under general anaesthesia.

CONCLUSIONS:

Neovaginal HPV infection can lead to benign condylomata (lrHPV) and various grades of dysplasia (hrHPV). We advise physicians to consider HPV infection and associated lesions in transgender women with otherwise unexplainable neovaginal pain or bleeding after vaginoplasty.

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By:  van der Sluis WB1, Buncamper ME2, Bouman MB2, Neefjes-Borst EA3, Heideman DA3, Steenbergen RD3, Mullender MG2.

• 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
• 2Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.
• 3Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands. 
• Sex Transm Infect. 2016 Mar 24. pii: sextrans-2015-052456. doi: 10.1136/sextrans-2015-052456.

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The Role of the Illusion in the Construction of Erotic Desire: Narratives from Heterosexual Men Who Have Occasional Sex with Transgender Women

Little is known about men's sexual desire for and erotic attraction to male-to-female transgender women. To better understand how erotic desire is constructed, this study examined the narratives of a sample of heterosexual men who had had an occasional sexual encounter with a transgender woman. 

Open-ended qualitative interviews were conducted with 16 heterosexual men who reported at least one sexual encounter with a transgender woman in the previous 12 months. Using principles of Grounded Theory, three themes emerged: 

1. the erotic desire that transpired from a transgender woman's construction of her femininity, 
2. the sexual act that dictated the specific navigation of a transgender woman's penis and 
3. the sexual dissonance that resulted from being a heterosexually identified man having sex with a partner who had a penis. 

These themes reflected how the participants defined and negotiated their sexual encounters, both psychologically through their understanding of sex with a transgender woman with a penis, and physically through the navigation of specific sex acts. 

The role of the 'illusion' was central to the meaning and construction of erotic desire. These narratives provided another framework for continuing discourse on the complexity of erotic desire.

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By:  Reback CJ1,2, Kaplan RL1,3, Bettcher TM4, Larkins S2.

• 1 Friends Research Institute, Inc. , Los Angeles , USA.
• 2 Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior , University of California at Los Angeles , California , USA.
• 3 Department of Obstetrics, Gynecology and Reproductive Sciences; Bixby Center for Global Reproductive Health , University of California at San Francisco , San Francisco , USA.
• 4 Department of Philosophy , California State University , Los Angeles , USA. 
• Cult Health Sex. 2016 Mar 11:1-13. 

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Examining the Sociocultural Context of HIV-related Risk Behaviors among Kathoey (Male-to-female Transgender Women) Sex Workers in Bangkok, Thailand

Kathoey (male-to-female transgender) sex workers (KSW) in Thailand are at high risk for sexually transmitted infections; however, few qualitative studies have been conducted to understand the sociocultural context of engaging in HIV risk behaviors. 

A total of 24 participants were purposively sampled in Bangkok based on KSW work venues and substance use. Results revealed the importance of participants' understanding of the self in relation to establishing economic independence through sex work, which could then be used to re-establish support from family, who often have not accepted a son's gender transition. 

Participants linked being kathoey to a belief in fate but did not view engagement in sex work in the same way. Different sex work venues exposed KSW to different risky situations. 

HIV prevention programs for kathoey must address the importance of economic security and its relation to social support and gender transition within a cultural- and work-environment-specific framework.

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By:  Nemoto T, Cruz T, Iwamoto M, Trocki K, Perngparn U, Areesantichai C, Suzuki S, Roberts C.

J Assoc Nurses AIDS Care. 2016 Mar-Apr;27(2):153-65. doi: 10.1016/j.jana.2015.11.003. Epub 2015 Nov 14.

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Staying in the Hood: Black Lesbian and Transgender Women and Identity Management in North Philadelphia

The concept "Don't Ask, Don't Tell" regarding Black LGBT sexuality in Black communities has been an acceptable form of identity management for Black LGBT people. In other words, Black LGBT people are accepted as long as they are not vocal about their sexuality. However, this is changing with the issue of gay marriage, which is creating a space where Black LGBT people are more open about their gender identity/sexuality in heterosexual Black spaces. 

This new form of openness allows Black LGBT people to 'stay in' their communities, as opposed to coming out. In this article I examine how Black LGBT women in North Philadelphia stay in their communities: being politically active regarding LGBT issues, disengaging from LGBT issues, passing, and educating straight Black people about issues affecting the Black LGBT community. I conclude with implications of staying in and intersectionality among Black heterosexual and LGBT women fighting for social change.

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By:  Brooks S1.

• 1 African American Studies, California State University at Fullerton, Fullerton, California, USA. 

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Medication Adherence among Transgender Women Living with HIV

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. 

This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. 

Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. 

Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies.

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By:  Baguso GN1, Gay CL2, Lee KA2.

• 1 Department of Community Health Systems , University of California , San Francisco , CA , USA.
• 2 Department of Family Health Care Nursing , University of California , San Francisco , CA , USA. 
• AIDS Care. 2016 Feb 24:1-6.

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Transgender Women & PrEP Video of Webinar

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HIV Self-Testing in Peru: Questionable Availability, High Acceptability But Potential Low Linkage to Care among Men Who Have Sex with Men & Transgender Women

HIV status awareness is key to prevention, linkage-to-care and treatment. Our study evaluated the accessibility and potential willingness of HIV self-testing among men who have sex with men (MSM) and transgender women in Peru. 

We surveyed four pharmacy chains in Peru to ascertain the commercial availability of the oral HIV self-test. The pharmacies surveyed confirmed that HIV self-test kits were available; however, those available were not intended for individual use, but for clinician use. 

We interviewed 147 MSM and 45 transgender women; nearly all (82%) reported willingness to perform the oral HIV self-test. However, only 55% of participants would definitely seek a confirmatory test in a clinic after an HIV-positive test result. Further, price may be a barrier, as HIV self-test kits were available for 18 USD, and MSM and transgender women were only willing to pay an average of 5 USD. 

HIV self-testing may facilitate increased access to HIV testing among some MSM/transgender women in Peru. However, price may prevent use, and poor uptake of confirmatory testing may limit linkage to HIV treatment and care.

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By:  Bustamante MJ1, Konda KA2, Joseph Davey D3, León SR1, Calvo GM4, Salvatierra J5, Brown B6, Caceres CF1, Klausner JD7.

• 1Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
• 2Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA.
• 3Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA dvoradavey@ucla.edu.
• 4Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru Epicentro Salud, Lima, Peru.
• 5Barton Health Center, Health Directorate of Callao, Lima, Peru.
• 6Center for Healthy Communities, Division of Clinical Sciences, UCR School of Medicine, Riverside, CA USA.
• 7Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA. 
• Int J STD AIDS. 2016 Jan 29. pii: 0956462416630674.

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Gender Characteristics and HIV/AIDS Related Knowledge Awareness and Behaviors of Transgender Women in China

OBJECTIVE:

To understand the gender characteristics, HIV/AIDS related knowledge awareness and behaviors of transgender women.

METHODS:

A questionnaire survey was conducted among the transgender women recruited through snowball sampling in Jinan in 2014, and descriptive epidemiologic analysis was conducted on the survey results.

RESULTS:

A total of 55 transgender women were surveyed, all of them were male physically and female psychologically. Serious gender conflict occurred in 27 subjects (49.1%), and very serious gender conflict occurred in 8 subjects (14.5%). Thirty subjects dressed up as a man in social life, accounting for 54.5%; 25 subjects dressed up as a women in social life, accounting for 45.5%. The average awareness rate of HIV/AIDS related knowledge was 57.9%(22/38). The awareness of knowledge about AIDS associated behaviors, such as multi sex partner and anal sex, was poor. For the lovers or sexual partners, 58.2% of the subjects (32/55) would choose males and 50.9% of the subjects (28/55) had chosen males, and for the sex partner at latest sex, 63.6%(35/55) of the subjects had chosen males. Up to 56.3% of the subjects had sex with casual sexual partners (net friends and partners of one-night stand) at latest sex behavior. Among the subjects surveyed, 18(32.7%) never used condoms; 29(52.7%) used condoms occasionally; 4(7.3%) used condoms frequently and 4(7.3%) used condoms at each sex.

CONCLUSIONS:

AIDS associated high risk behaviors were common among the transgender women, such as unprotected anal sex, multiple sexual partners, frequent sex and poor condom use. It is necessary to conduct the study of the HIV infection prevention in transgender women.

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By:  Chen WK1, Zhang XF2, Lyu CX2, Dong L2, Du YH1, Fu JH2.

• 1Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan 250012, China.
• 2Shandong Association for AIDS Prevention and Control, Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, China.
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Jan 10;37(1):76-9. doi: 10.3760/cma.j.issn.0254-6450.2016.01.016. 

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Sexual Orientation, Gender Identity and Perceived Source of Infection among Men Who Have Sex with Men and Transgender Women (TW) Recently Diagnosed with HIV and/or STI in Lima, Peru

Risk perception and health behaviors result from individual-level factors influenced by specific partnership contexts. 

We explored individual- and partner-level factors associated with partner-specific perceptions of HIV/STI risk among 372 HIV/STI-positive MSM and transgender women (TW) in Lima, Peru. 

Generalized estimating equations explored participants' perception of their three most recent partner(s) as a likely source of their HIV/STI diagnosis. Homosexual/gay (PR = 2.07; 95 % CI 1.19-3.61) or transgender (PR = 2.84; 95 % CI 1.48-5.44) partners were more likely to be considered a source of infection than heterosexual partners. 

Compared to heterosexual respondents, gay and TW respondents were less likely to associate their partner with HIV/STI infection, suggesting a cultural link between gay or TW identity and perceived HIV/STI risk. 

Our findings demonstrate a need for health promotion messages tailored to high-risk MSM partnerships addressing how perceived HIV/STI risk aligns or conflicts with actual transmission risks in sexual partnerships and networks.

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By:  Blair CS1, Segura ER2, Perez-Brumer AG2,3, Sanchez J4, Lama JR4, Clark JL2.

• 1Division of Infectious Diseases and Program in Global Health, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. cherieblair@mednet.ucla.edu.
• 2Division of Infectious Diseases and Program in Global Health, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
• 3Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
• 4Asociación Civil Impacta Salud y Educación, Lima, Peru. 
• AIDS Behav. 2016 Jan 14.

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