Study finds increased STI risk among transgender women with HIV

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A recent study found that transgender women with HIV face elevated risks of bacterial sexually transmitted infections, emphasizing the need for tailored interventions and further research to address the distinct challenges faced by this population.

Study finds increased STI risk among transgender women with HIV | Image Credit: © ink drop - © ink drop - stock.adobe.com.

Study finds increased STI risk among transgender women with HIV | Image Credit: © ink drop - © ink drop - stock.adobe.com.

Transgender women (TGW) with HIV have increased rates of bacterial sexually transmitted infections (STIs), according to a recent study published in the Journal of Infectious Diseases.

Takeaways

  1. The study reveals that transgender women (TGW) with HIV experience increased rates of bacterial sexually transmitted infections (STIs), compared to those without HIV.
  2. HIV and other STIs are more common in TGW, with HIV rates being 14% higher than 42 times the national prevalence of 0.3% in this population.
  3. The study suggests that HIV may increase STI risk among TGW because of intersectional stigma and discrimination, highlighting the importance of addressing social factors in healthcare.
  4. Non-Hispanic Black and Hispanic TGW, both with and without HIV, face significantly increased rates of any bacterial STI compared to non-Hispanic White TGW.
  5. The findings underscore the need for future research to identify STI determinants unique to TGW with and without HIV, emphasizing the importance of tailored interventions and healthcare strategies for this population.

STIs, which increase HIV transmission and acquisition risks and decreases quality of life, has had increased rates in the United States over time. HIV and other STIs are more common in TGW, with HIV rates increased by 14% more than 42 times the national prevalence of 0.3% in this population.

HIV may increase STI risk among TGW because of intersectional stigma and discrimination. Data has indicated increased burden for other STIs among TGW, but this information remains limited to clinical-based samples.

To determine the prevalence and correlates of bacterial STIs among TGW based on HIV status, investigators conducted a cross-sectional study. Data was obtained from the Leading Innovation for Transgender Women’s Health and Empowerment study, which evaluated HIV incidence and health outcomes among TGW living in the eastern and southern United States.

Participants included transfeminine individuals aged 18 years and older living in a site-based city. Final enrollment was restricted to individuals without HIV at baseline. All participants underwent a facility-based study visit, including a socio-behavioral survey, laboratory-confirmed HIV and bacterial STI testing, and specimen collection.

Bacterial STI testing included assessments of self-collected urine, anorectal, and vaginal swabs for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection. Participants in Baltimore also received antibody testing for Treponema pallidum, followed by rapid plasma reagin testing used to determine syphilis presence.

HIV status was confirmed using the OraQuick In-Home HIV Test (OraSure Technologies). The prevalence of at least 1 STI including CT, GC, or syphilis was measured as the primary outcome of the analysis.

Covariates included race and ethnicity, age, gender identity, geographic region, educational attainment, marital status, sexual activity, partner concurrency, any condomless anal or vaginal sex, health care access, socio-structural factors, substance use, health insurance status, and receipt of gender affirming care.

There were 1018 patients included in the final analysis, aged a median 31 years. Of patients, 29% were non-Hispanic Black, 27% Hispanic, 27% had HIV, and 8% self-reported a history of vaginoplasty. Overall, any STI was reported in 16% of participants, CT in 5%, GC in 2%, and syphilis in 11%.

Rates of any bacterial STI, CT, GC, and syphilis were increased among TGW with HIV compared to those without HIV, with prevalence ratios (PR) of 2.99, 1.76, 2.27, and 4.95, respectively. The adjusted prevalence ratios (aPR) for any bacterial STI and syphilis remained significant among TGW with HIV after covariate adjustments, at 1.91 and 2.62, respectively.

STI co-infection rates were 0.8% among TGW without HIV and 5% among TGW with HIV. Non-Hispanic Black and Hispanic TGW had significantly increased rates of any bacterial STI compared to non-Hispanic White TGW, with PRs of 8.03 and 4.77, respectively.

Among TGW without HIV, factors associated with increased STI risk included residing in Upper and Lower South Atlantic regions and identifying as gender nonbinary, genderqueer, or another gender identity. In an adjusted model, older age was inversely associated with a bacterial STI among TGW with HIV, with an aPR of 0.93.

These results highlight differential burdens and needs related to STIs among women with and without HIV. Investigators concluded future research should find STI determinants unique to TGW with and without HIV.

Reference

Brown EE, Patel EU, Poteat TC, et al. Prevalence of sexually transmitted infections among transgender women living with and without HIV in the eastern and southern United States. J Infect Dis. 2024. doi:10.1093/infdis/jiad605

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