Oral health care is a critical component of comprehensive HIV medical management. Development of oral pathology is frequently associated with an underlying progression of HIV-disease status. A thorough soft-tissue examination may reveal pathology associated with dysphagia or odynophagia. Dental problems can result in or exacerbate nutritional problems. In addition, psychosocial and quality-of-life issues frequently are associated with the condition of the oral cavity and the dentition.
Meningococcal FFtm. Resources for Consumers. Worldwide burden of HIV in transgender Ftm hiv a systematic review and meta-analysis. Yes, I will give feedback—take me to the survey now. Testosterone causes thinning and dryness or vaginal mucosa which increases Ftm hiv of bleeding and tearing during sex. Top of Page. Scroll To Top. Data regarding HIV rates in transgender people is often difficult to find as female to male FTM and male to female MTF are not gender classifications typically biv on many surveillance reports. Not only does this complicate efforts for prevention outreach, Ftm hiv used to effect outreach are often non-specific to Beaver creek colorado homes population or, worse yet, gender biased.
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AnastaziaDrago In some instances, the SOC notes, it may be acceptable to provide hormones to patients who have not fulfilled the third criteria -- for example, to facilitate the provision of monitored therapy using hormones of known quality, as an alternative to black-market or unsupervised hormone use. I love the feeling of being Ftm hiv. Website Feedback. I might remake this one, not too sure yet Pulling on my tail gets me so turned on. Campaigns Many Federal agencies have developed public Ftm hiv and education campaigns to hic HIV prevention, treatment, care, and research. I was told to Ftm hiv in a public men's shower jiv. Just Detention International provides legal and self-help resources to survivors of and people at risk for sexual assault in prisons Adrianne s pantyhose review jails, juvenile facilities, immigration detention centers, and police lock-ups. Individuals may self-identify as either, both, or choose another identity altogether. Sometimes I can saline
Data regarding HIV rates in transgender people is often difficult to find as female to male FTM and male to female MTF are not gender classifications typically noted on many surveillance reports.
- Transgender persons illuminate the complex interplay of social and biological factors that determine gender identity an individual's own sense of maleness or femaleness and contribute to both HIV risk and HIV health.
- Many Federal agencies have developed public awareness and education campaigns to address HIV prevention, treatment, care, and research.
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Data regarding HIV rates in transgender people is often difficult to find as female to male FTM and male to female MTF are not gender classifications typically noted on many surveillance reports. A study concluded that among the transgender population in California, 6.
This was that highest prevalence rate of any group in the state, including men who have sex with men MSM. HIV among the transgender population remains an important, and understudied, social issue. Sociocultural perceptions about sex and gender work to marginalize the community as a whole, placing transgender men and women at increased vulnerability to infection and disease progression. The term transgender is an inclusive term for a person whose gender identity and expression differ from what's expected as a result of their birth gender.
Gender identities falling under the umbrella of transgender include:. It is not uncommon for people to confuse gender identity and sexual orientation, or to connect the two when no association is present. By definition, sexual orientation describes a pattern of emotional, romantic, or sexual attraction to another person.
The scientific consensus is that sexual orientation is not a choice and is instead influenced by a combination of hormonal and genetic factors early in uterine development. Gender identity, by contrast, refers to the gender or genders a person identifies as. Gender identity can change over time and does not always relate to sexual orientation. For instance, if someone born male identifies as female, she could be bisexual, heterosexual or homosexual.
While transmission routes in the transgender community are much the same as any other population, there are some factors that place transgender people at a higher HIV risk. Gaps in treatment, care and outreach are evident in communities where transgender HIV rates run high.
Increasing effort is being made to fill these gaps, integrating transgender-specific services that provides community members safe and confidential access to testing, medications and support.
Get information on prevention, symptoms, and treatment to better ensure a long and healthy life. Crossdresser - one who wears clothes usually assigned to the opposite sex Bi-gender - those who feel their gender identity encompasses both male and female Transsexual - those who find their gender identity is in conflict with their anatomical sex.
These individuals feel their physiological body does not represent their true gender self. Transvestite - another outdated term for a crossdresser Cisgender - one who identifies with the gender they were assigned at birth Genderqueer - used to describe a person who identifies as both male and female; neither male not female; or a gender outside the traditional two gender male and female system.
The fears and risk of disclosure often makes it difficult to identify and reach members of the transgender community. Not only does this complicate efforts for prevention outreach, materials used to effect outreach are often non-specific to the population or, worse yet, gender biased. By and large, those who identify as transgender perceive their anatomy differently than the medical community would. Without a common point of reference, health promotion and education becomes difficult. The medical community is frequently insensitive to this identification chasm, making health promotion and education all the more difficult.
Those identifying as transgender often experiment sexually and can sometime perceive risk differently—say, between to MTF transgenders identifying as lesbians.
In addition, many are involved in sex work to support substance addictions; to make money for hormonal therapy; or because employment discrimination places them at economic vulnerability. Needle sharing is common among those who inject hormones increasing even further the risk of transmission. Key points of transgender-specific HIV services:. Providers must understand the needs of the transgender community and remain sensitive to issues of gender identification and personal identity.
Insurance companies must understand the importance of hormonal therapy and make better effort to provide affordable treatment with supportive care. Prevention education needs to be targeted specific to the transgender community in a manner that is sensitive to their needs, concerns and fears.
Individual providers must make special care to ensure their patients feel safe disclosing their gender identities and to respect the terms of those identities once disclosed i. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Article Sources.
Source: Herbst, J. January ; 2 1 Continue Reading.
MMWR ;— Risk behaviors and psychosocial stressors in the New York City House Ball community: a comparison of men and transgender women who have sex with men. Care for a neovagina includes periodic dilation to prevent stenosis narrowing. Or are you new to this field? Thus sex, which is given at birth, does not determine gender or sexual orientation; neither does gender determine sexual orientation or vice versa.
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For example, one study found that the majority of MTF in the study sample identified as heterosexual and had biologically male sex partners. The general lack of inclusion of gender-variance variables in health surveys makes collecting true estimates of the transgender population and the transgender HIV positive population that much more difficult. While the terms MTF and FTM are commonly used, it is important to note that these are medicalized terms and do not necessarily represent the identities of all individuals who fall under the "transgender" umbrella.
Since no true population-based studies have been conducted and U. In addition to being derived from geographically limited samples, these figures are based on the number of transgender persons seeking mental health care or medical treatment, and may therefore dramatically underestimate the true number of individuals who identify as transgender.
Despite the tremendous gaps in our knowledge about the extent of the transgender population, however, it is necessary to look at what data do exist for a better understanding of the effect of HIV on the transgender community. A recent meta-analysis by Jeffrey Herbst of the U.
Centers for Disease Control and Prevention and colleagues estimated a U. HIV prevalence of However, lack of knowledge of transmission and prevention means, the misperception that FTM are at intrinsically low risk for HIV, and inconsistent use of latex barrier methods during vaginal and anal sex may all increase risk for FTM individuals. For free technical assistance, consultation, and tailored trainings for health professionals who work with transgender clients, contact the Center of Excellence for Transgender HIV Prevention www.
The San Francisco Department of Public Health has been collecting health-related data on transgender persons from medical records since ; however, as with national and state-wide data, these data vary by study, depending largely on whether data are gathered through testing or self-report. The state of California and the city and county of San Francisco are notable in their attempts to collect epidemiological data for the transgender population.
Transgender persons have the overall highest HIV diagnosis rate 6. Transgender persons face myriad challenges that place them at increased risk for HIV infection.
Precarious economic status, substance use, low self-esteem, social vulnerability, and lack of social support are common barriers to adopting and maintaining safer behaviors that can prevent the acquisition or transmission of HIV. Economic marginalization as a result of institutional discrimination, stigma, and lower levels of education contributes to a severe lack of opportunity for many transgender persons.
Studies have found that over one-third of MTF have experienced job discrimination, over one-fifth report income below the U. Such marginalization may lead MTF to engage in commercial sex work as a means of economic support. Many MTF find that sex work offers a sense of social connection with other transgender persons, but sex work amplifies the risk of HIV transmission for MTF and their partners. Not only is HIV prevalence high among MTF engaged in sex work, it also appears that their infection rates are as much as four times higher than those of genetically female sex workers.
HIV risk among MTF is not limited to exposure through sex work, however; sexual practices and partnership arrangements also play a role. The desire to affirm a feminine gender identity may lead MTF to have concurrent multiple sex partners and unprotected receptive anal intercourse URAI in high-risk sexual networks with higher HIV prevalence.
Many MTF turn to substances to cope with discrimination, transphobia, and the sex-work environment. These substance-use behaviors are established risk factors for HIV infection. As in other populations, substance use among MTF persons is linked to mental health issues. Transgender persons are also nearly twice as likely as non-transgender men or women to have considered or attempted suicide.
MTF may feel socially marginalized due to an absence of social support, rejection by their peers and families, and a lack of connection to the lesbian, gay, and bisexual community, intensifying the risk of HIV transmission and disease progression.
Transgender persons report the lowest levels of family support compared with MSM and women who have sex with both men and women. Rejection from family and peers may lead to alienation and feelings of hopelessness, and may increase psychological and social vulnerability -- which may, in turn, increase HIV risk. For example, condoms may be perceived as undermining intimacy with primary partners, while sex with casual partners and willingness to engage in URAI may provide gender validation and a sense of attractiveness that MTF may not get from peers, family, and the larger society.
HIV risk thus stems in part from willingness to engage with sexual partners who provide a sense of love and acceptance but who may also request unprotected sex.
The dangers of pump parties are clear. Clean needles and a sterile environment may not always be available, putting participants at risk for HIV, hepatitis, and other infections. Silicone procured outside of a medical setting is often not medical grade but industrial -- in fact, it may have come straight from the plumbing department of a hardware store -- and is sometimes mixed with paraffin, motor oil, cooking oil, antifreeze, or other non-sterile materials to make it flow more easily through the syringe and into body tissues.
Most such silicone injections are ultimately disfiguring, as the silicone migrates, changes shape, or hardens over time. Despite a long history of fatalities, infections, severe local tissue damage, and disfigurement, injecting "street" silicone is still seen as a viable way to feminize the face and body and help a transgender woman "pass," and thus avoid discrimination, gain employment, and attract intimate partners. Body modification, such as hormone therapy, may offer the benefits of affirming gender identity and both improving self-esteem and reducing discrimination by potential employers and others.
However, unless monitored by a competent and knowledgeable health care provider, it may also create significant risk for HIV and other illnesses. Hormones procured outside of a medical setting on the street, for example are typically injected rather than taken orally, and needle sharing may lead to increased risk for acquiring or transmitting HIV and or other bloodborne diseases.
Unsanitary silicone injecting is also common despite the risk of transmitting or acquiring HIV, hepatitis B and C, and multidrug-resistant Staphylococcus aureus MRSA , as well as the danger of foreign substance reactions, in which the body rejects the silicone see sidebar below. Nonetheless, many transgender persons who share syringes to inject hormones or silicone do not identify themselves as "drug users" and may not see the potential risk of what is, in fact, needle sharing.
Patients request hormones -- synthetic versions of chemicals that naturally occur in the body and promote sexlinked characteristics, like breast growth -- to develop physical features that allow them to express their gender identity.
Hormones are available as pills and injections and in transdermal preparations delivered through the skin as creams, gels, or patches. FTM persons may choose to take testosterone to increase body hair, deepen the voice, and develop more muscle mass, while MTF individuals may opt to take estrogen to enlarge the breasts, lose body and facial hair, transfer fat from the gut to the hips, and soften the skin.
Hormone therapy can have the added benefit of connecting transgender people with medical care, including treatment for HIV and other chronic illnesses and education about HIV prevention. The table summarizes the types of hormones and hormone-altering drugs and procedures used for feminization and masculinization, along with the permanent and temporary effects, risks, contraindications, and benefits and disadvantages of each.
The SOC is a consensus on psychiatric, psychological, medical, and surgical management of GID and protocols for hormonal reassignment of gender.
Many physicians and transgender persons oppose the GID diagnosis, not viewing transgenderism as a "disorder" but rather as a natural, healthy expression of the range of gender variations that are part of the human experience.
Nonetheless, the SOC guidelines are commonly used for assessing mental health in transgender adults and children, and for managing surgery and hormone treatment in this toooften neglected population.
According to the SOC, in order to begin hormone therapy, individuals should:. Demonstrate knowledge of what hormones can and cannot do medically, and their social benefits and risks;. In some instances, the SOC notes, it may be acceptable to provide hormones to patients who have not fulfilled the third criteria -- for example, to facilitate the provision of monitored therapy using hormones of known quality, as an alternative to black-market or unsupervised hormone use.
Hormone therapy for transgender persons is highly individualized and should include medical monitoring. A number of contraindications must be discussed with a knowledgeable heath care provider before hormone use begins, including a history of breast cancer or thrombosis blood clots and active substance abuse, as well as use of antiretroviral drugs to manage HIV disease.
Health recommendations for those who wish to begin hormone treatment include smoking cessation, regular exercise, and reducing risk factors for cardiovascular disease. Transdermal or intramuscular hormones may be recommended for older individuals or those with other non-age-related risk factors for blood clots.
A large Dutch cohort showed that prescribed and monitored hormone therapy did not increase mortality; rather, the number-one cause of death in this cohort was suicide. As discussed previously, many transgender persons have attempted or committed suicide and often struggle with mental illness. Thirty-two percent of a San Francisco-based sample of transgender persons had attempted suicide; younger age, depression, substance abuse, and a history of forced sex, genderbased discrimination, or gender-based victimization were associated with attempted suicide.
Thus, in addition to a full medical history, a complete psychosocial history should be taken and any necessary mental health treatment should be initiated before beginning hormone therapy, to ensure the best possible outcome. When obtained on the black market, hormones come with no quality assurance, recommended dosages, or medical monitoring.
Some transgender persons obtain hormones illegally to supplement prescribed hormones and speed up or intensify the desired effects, which puts these individuals at increased risk for unwanted side effects and drug interactions.
Medical monitoring is essential to safe and healthy hormone use. An Amsterdam cohort study reported 36 incidents of blood clots in subjects over patient-years. Most occurred in the first year of taking estrogens and most were in persons over age 40 who were taking oral ethinyl estradiol; of these, participants who switched to transdermal ethinyl estradiol saw their risk for blood clots decline.
While breast cancer may be a concern for transgender women, there have only been three reported cases in worldwide medical literature. Treatment with hormones may provide an opportunity for patients to address HIV disease. Cross-gender hormone therapy is not contraindicated in HIV-positive people on antiretroviral therapy ART at any stage of HIV-disease progression, although health care providers may still be wary, as there is so little medical literature on interactions between hormone therapy and antiretroviral drugs or the impact of hormones on CD4 counts for transgender persons.
There is some evidence that certain HIV medications do impact hormone levels; for example, TWHC advises extreme care with the protease inhibitor indinavir Crixivan and the non-nucleoside reverse transcriptase inhibitor efavirenz Sustiva , as they may increase levels of ethinyl estradiol, a form of the hormone estrogen.
TWHC also advises transgender patients on hormone therapy to avoid the protease inhibitors fosamprenavir Lexiva and amprenavir Agenerase; no longer widely available in the U. It is important to note that the quantities of hormones required for feminization and masculinization have not been thoroughly tested for interactions with other drugs.
Drug interactions involving ethinyl estradiol -- a form of estrogen used in birth control pills -- offer some hints, but much higher doses of ethinyl estradiol are prescribed for hormone therapy for transgender persons compared with those taken for birth control. Decreased or increased levels of ethinyl estradiol in the body may lead to unwanted side effects, ranging from inadequate feminization of physical features to nausea and vomiting, headache, and drowsiness.
Sex reassignment surgery SRS -- also called "gender confirmation surgery" -- includes a number of surgical options see sidebar which transgender persons may or may not choose to have, depending on their gender identity. The WPATH Standards of Care state that "it is unethical to deny availability or eligibility for sex reassignment surgeries or hormone therapy solely on the basis of blood seropositivity for blood-borne infections such as HIV, or hepatitis B or C, etc.
As with any surgery, the quality of the care the patient receives before, during, and after SRS is a major factor in how well and how quickly the individual recovers, and his or her satisfaction with this part of the transition experience.
For both MTF and FTM persons, pre-procedure communication with surgeons and other members of the health care team is essential to a healthy recovery -- and to avoiding acquiring or transmitting HIV following surgery.
Individuals should make sure they understand how long the healing time is for genital surgeries; sexual activity too soon may allow HIV to enter the body through unhealed surgical wounds or may put partners at risk for HIV transmitted through blood from surgical sites.
Once healing is complete, safersex tools like male or female condoms, dental dams, and latex gloves cut to fit a new "microphallus" can help protect the transgender individual and his or her sex partners from HIV and other sexually transmitted infections.
Transgender women with neovaginas should be aware that most reconstructed vaginas cannot lubricate naturally; using a personal lubricant is recommended to decrease the likelihood that sex will cause abrasions and small tears through which HIV and other pathogens can pass.
Care for a neovagina includes periodic dilation to prevent stenosis narrowing. Microscopic tears caused by dilation or sex create ideal conditions for acquiring or transmitting HIV if barrier protection is not used during sexual intercourse. In addition, the medical care team should be aware of any and all medications including ART the individual undergoing surgery is using to ensure continuity and avoid drug interactions during and after surgery.
And regardless of their HIV status, transgender individuals who have had any sex reassignment surgery but retain pretransition organs or tissue remnants need regular screening for cancers commonly associated with their birth sex, including prostate, breast, cervical, and ovarian cancers. Routinize it, make it ordinary -- but at the same time acknowledge that, for many transgender patients, their past has been very challenging and overwhelming.
Because transgender health needs are complex and may intimidate health care providers, and due to the general lack of culturally competent medical settings, transgender people may struggle to find appropriate medical care. Lack of stable employment and other financial barriers may also hinder access to health insurance and medical care. Other barriers to care include fear of exposure or disclosure, geographic isolation, social isolation, and a dearth of transgender-specific clinical research and medical literature.
Lack of gender-variance variables on medical history forms may also present an obstacle to care. In addition, health insurance policies may not cover expensive treatments and surgeries sought by many transgender people; most insurance companies, employee health plans, and health maintenance organizations HMOs specifically exempt coverage for sex reassignment surgery, hormones, and electrolysis, deeming them elective or cosmetic. In a fourcity study of antiretroviral drug use, for example, transgender persons had significantly lower rates of ART use compared with other populations.
Important guidelines developed by the Center of Excellence for Transgender HIV Prevention encourage medical providers to ask themselves whether the questions they are posing to transgender clients are medically necessary and relevant to their work. At the same time, it is essential that patient-provider communication be open and frank in order to ensure the best possible care.
Just like you can't make any assumptions on sexual behavior based on whether someone is gay or straight, we really don't know anything about what if any medical, hormonal, or surgical treatments a trans person has had short of taking a focused and detailed history. The following simple practices, recommended by WPATH and TWHC, can help medical providers offer a comfortable environment and sensitive treatment for transgender clients.
Gender identity is relevant both to why transgender people are arrested and to their needs once they are brought into the justice system.
Social stigma and difficulty finding or maintaining employment, low self-esteem, substance use, and a need to fund hormones and surgery may lead to commercial sex work and, hence, incarceration. Placement in incarceration facilities is typically "genitalia-based": birth sex or current anatomy, rather than gender identity, determines where transgender prisoners are housed. This contributes to an increased risk of HIV exposure, as transgender prisoners may be targeted for rape, coerced sex, and coerced prostitution.
It is generally agreed and supported by the SOC that inmates should continue taking hormones prescribed prior to incarceration, as sudden cessation of hormone therapy may have serious medical consequences, including undesired regression of hormonally induced physical changes, emotional instability, and depression, anxiety, or suicide.
Am J Public Health Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health ; 9 Age of individuals who identify as transgender in the United States.
Accessed January 28, Virgin Islands, July Funding opportunity announcement: PS Comprehensive high-impact HIV prevention projects for community-based organizations. AIDS Behav ; December De Santis JP. HIV infection risk factors among male-to-female transgender persons: a review of the literature.
How many adults identify as transgender in the United States? June Life Skills: evaluation of a theory-driven behavioral HIV prevention intervention for young transgender women. J Urban Health ;89 3 Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav ;12 1 Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women.
James, S. The Report of the U. Transgender Survey. Transgender population size in the United States: a meta-regression of population-based probability samples.
Am J Public Health ; 2 :e1-e8. LGBT Health ;2 00 J Acquir Immun Def Syndr ;52 3 — A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men.
The risk less known: female-to-male transgender persons' vulnerability to HIV infection.
Over two-thirds 69 percent had an unmet support needs and a quarter were currently living with depression. The study goes on to say, that transgender men need their own studies to address their unique needs. Rongitsch agrees there needs to be more studies that include trans individuals around HIV, especially in regards to PrEP.
Testosterone causes thinning and dryness or vaginal mucosa which increases risk of bleeding and tearing during sex. While there aren't studies specifically looking at this, I believe trans men may be at higher risk of contracting HIV if exposed to the virus, compared to cisgender women.
Studies looking at PrEP efficacy in cis women might not apply to trans men as they might be at higher risk. Care is becoming more accessible in many parts of the country, awareness among medical providers is increasing, and we are starting to see more focus on trans health research — all positive steps to remedy decades of terrible disparities in healthcare for trans individuals.
All cis women have some testosterone and there is a wide variation in testosterone levels in cis and trans men. There are obvious differences between cis and trans guys who have sex with men — for those men who have front sex we need to screen for pregnancy and STI testing needs to include trichomoniasis. This is one of the main reasons why the uptake is low, for all people of trans experience. Perry Halkitis , head of the Rutgers School of Public Health, adds, "The problem I see in the literature, reminds me very much of the early days of AIDS when all of the trials on medication were being done on men and then what ended up happening is the women started taking meds and having really awful side effects.
Somebody should have thought, 'You know, we should have women in these trials too. The folks in the study were 18 when they started, a sub set of them are transitioning. We've been funded for two cycles and we're going back next year. We're going to ask for more money to study the trans and non-conforming folks separately because we can't keep studying them the same.
The challenge is trying to manage these conversations in a way that recognize that one doesn't have to be at the expense of the other. That's my job as a leader to do that.
It's not just about the hormones and biology, there is psychology and social conditions. When you treat the health of a trans person you have to think about all of those things. All Rights Reserved. Search form Search. Scroll To Top. I Am The First. Without studies that separate trans men from cis women, the disparity will continue.
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