HIV Prevalence and High-Risk Subgroup Identification in Transgender Women Who Undergo Primary Vaginoplasty in the Netherlands

Overview

Journal Transgend Health

Date 2023 Jun 21

PMID 37342478

Authors

Ceranza G Daans

Elske Hoornenborg

Kristin B de Haseth

Mujde Ozer

Mark-Bram Bouman

Elfi Conemans

Baudewijntje P C Kreukels

Martin den Heijer

Wouter B van der Sluis

Affiliations

Soon will be listed here.

Abstract

Purpose: Worldwide, transgender women (TGW) bear a high HIV burden. Limited data are available on HIV prevalence and risk factors among TGW in western European countries. Our aim is to assess the prevalence of TGW living with HIV who underwent primary vaginoplasty in an academic reference hospital and to identify high-risk subgroups.

Methods: All TGW who underwent primary vaginoplasty between January 2000 and September 2019 at our institution were identified. A retrospective chart study was conducted, recording the medical history, age at vaginoplasty, region of birth, use of medication, injecting drug use, history of pubertal suppression, HIV status, and sexual preference at time of surgical intake. High-risk subgroups were identified using logistic regression analysis.

Results: Between January 2000 and September 2019, a total of 950 TGW underwent primary vaginoplasty, of whom 31 (3.3%) individuals were known to live with HIV. Prevalence of HIV was higher in TGW born outside of Europe (20/145, 13.8%) than among those born in Europe (11/805, 1.4%), <0.001. In addition, having a sexual preference toward men was significantly associated with HIV. None of the TGW living with HIV had a history of puberty suppression.

Conclusion: The HIV prevalence in our study population is higher than the reported HIV prevalence in cisgender population in the Netherlands but lower than reported in previous studies in TGW. Further studies should investigate the need and feasibility of routine HIV testing of TGW in Western countries.

References

Poteat T, Scheim A, Xavier J, Reisner S, Baral S . Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. J Acquir Immune Defic Syndr. 2016; 72 Suppl 3:S210-9. PMC: 4969059. DOI: 10.1097/QAI.0000000000001087. View

Mole R, Parutis V, Gerry C, Burns F . The impact of migration on the sexual health, behaviours and attitudes of Central and East European gay/bisexual men in London. Ethn Health. 2013; 19(1):86-99. PMC: 4095972. DOI: 10.1080/13557858.2013.789829. View

Le V, Arayasirikul S, Chen Y, Jin H, Wilson E . Types of social support and parental acceptance among transfemale youth and their impact on mental health, sexual debut, history of sex work and condomless anal intercourse. J Int AIDS Soc. 2016; 19(3 Suppl 2):20781. PMC: 4949317. DOI: 10.7448/IAS.19.3.20781. View

Druckler S, S van Rooijen M, de Vries H . Substance Use and Sexual Risk Behavior Among Male and Transgender Women Sex Workers at the Prostitution Outreach Center in Amsterdam, the Netherlands. Sex Transm Dis. 2020; 47(2):114-121. DOI: 10.1097/OLQ.0000000000001096. View

Doorduin T, van Berlo W . Trans people's experience of sexuality in the Netherlands: a pilot study. J Homosex. 2013; 61(5):654-72. DOI: 10.1080/00918369.2014.865482. View

Baral S, Poteat T, Stromdahl S, Wirtz A, Guadamuz T, Beyrer C . Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2012; 13(3):214-22. DOI: 10.1016/S1473-3099(12)70315-8. View

van Veen M, Gotz H, van Leeuwen P, Prins M, van de Laar M . HIV and sexual risk behavior among commercial sex workers in the Netherlands. Arch Sex Behav. 2008; 39(3):714-23. DOI: 10.1007/s10508-008-9396-z. View

De Santis J . HIV infection risk factors among male-to-female transgender persons: a review of the literature. J Assoc Nurses AIDS Care. 2009; 20(5):362-72. DOI: 10.1016/j.jana.2009.06.005. View

Benotsch E, Zimmerman R, Cathers L, Pierce J, McNulty S, Heck T . Non-medical use of prescription drugs and HIV risk behaviour in transgender women in the Mid-Atlantic region of the United States. Int J STD AIDS. 2015; 27(9):776-82. DOI: 10.1177/0956462415595319. View

10.

Deblonde J, Sasse A, Del Amo J, Burns F, Delpech V, Cowan S . Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. BMC Public Health. 2015; 15:1228. PMC: 4676131. DOI: 10.1186/s12889-015-2571-y. View

11.

de Vries A, McGuire J, Steensma T, Wagenaar E, Doreleijers T, Cohen-Kettenis P . Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014; 134(4):696-704. DOI: 10.1542/peds.2013-2958. View

12.

Bungener S, Steensma T, Cohen-Kettenis P, de Vries A . Sexual and Romantic Experiences of Transgender Youth Before Gender-Affirmative Treatment. Pediatrics. 2017; 139(3). DOI: 10.1542/peds.2016-2283. View

13.

Cerwenka S, Nieder T, Cohen-Kettenis P, De Cuypere G, Haraldsen I, Kreukels B . Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study. J Sex Marital Ther. 2014; 40(5):457-71. DOI: 10.1080/0092623X.2013.772550. View

14.

Bouman M, van der Sluis W, van Woudenberg Hamstra L, Buncamper M, Kreukels B, Meijerink W . Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women With Penoscrotal Hypoplasia. J Sex Med. 2016; 13(9):1438-1444. DOI: 10.1016/j.jsxm.2016.06.009. View

15.

Cohen-Kettenis P, Schagen S, Steensma T, de Vries A, Delemarre-van de Waal H . Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up. Arch Sex Behav. 2011; 40(4):843-7. PMC: 3114100. DOI: 10.1007/s10508-011-9758-9. View

16.

Poteat T, German D, Flynn C . The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Glob Public Health. 2016; 11(7-8):835-48. PMC: 4957661. DOI: 10.1080/17441692.2015.1134615. View

17.

McNulty A, Bourne C . Transgender HIV and sexually transmissible infections. Sex Health. 2017; 14(5):451-455. DOI: 10.1071/SH17050. View

18.

Clements-Nolle K, Marx R, Guzman R, Katz M . HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001; 91(6):915-21. PMC: 1446468. DOI: 10.2105/ajph.91.6.915. View

19.

Nemoto T, Bodeker B, Iwamoto M, Sakata M . Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables. AIDS Care. 2013; 26(4):434-40. DOI: 10.1080/09540121.2013.841832. View

20.

Reback C, Clark K, Holloway I, Fletcher J . Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998-1999 to 2015-2016. AIDS Behav. 2018; 22(8):2524-2533. PMC: 6280971. DOI: 10.1007/s10461-018-2165-7. View