Understanding and Addressing Human Immunodeficiency Virus and Sexually Transmitted Disease Disparities among Transgender Persons

Luzzati et al contribute to the evidence of the global human immunodeficiency virus (HIV) disparity among male-to-female transgender persons with their article, Prevalence of human immunodeficiency virus, hepatitis B virus and hepatitis C virus infections among transgender persons referred to an Italian center for total sex-reassignment surgery (SRS). Italy is one of only a few countries in the world that allows individuals to change their official gender without having SRS. Additionally, SRS is provided free of charge through 7 SRS clinics, following a psychological assessment and court ruling. Despite this seemingly favorable gender and health care policy context, the 12.1% HIV prevalence among male-to-female transgender women found in this study is still substantially higher than the estimated adult HIV prevalence in Italy of less than 1%, which could reflect the cumulative effects of stigma, discrimination, and social exclusion experienced by transgender populations. Also of concern, Luzzati and colleagues found that HIV prevalence was significantly higher in the more recent cohort (2010 to 2014) of SRS clients, suggesting that there are prevailing gaps in the social and structural protections needed to promote health and wellbeing, including HIV prevention, among transgender persons in Italy. In the United States, where SRS is not universally accessible, users of SRS services were found to have significantly lower estimated odds of suicidal ideation, binge drinking, and noninjection drug use, which could either reflect that receiving these services can promote mental health and reduce HIV risk or that those who can access such services are already experiencing better health. Of note, in the United States, Latina and African American transgender women are significantly less likely to use SRS services, which reflects patterned disparities in healthcare access and HIV prevalence across race and ethnicity.