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Transform what? A snapshot of HIV/AIDS among Transgender People JoAnne G. Keatley, MSW Director and Co-Principal Investigator Center of Excellence for.

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Presentation on theme: "Transform what? A snapshot of HIV/AIDS among Transgender People JoAnne G. Keatley, MSW Director and Co-Principal Investigator Center of Excellence for."— Presentation transcript:

1 Transform what? A snapshot of HIV/AIDS among Transgender People JoAnne G. Keatley, MSW Director and Co-Principal Investigator Center of Excellence for Transgender Health University of California San Francisco

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3  Sharing of best practices in addressing comprehensive transgender healthcare – including HIV.  Current advancements, resources and challenges will be shared as “building blocks” for the development of a road map to ensure access in a variety of settings.

4  We will hear from a variety of civil society stakeholders, including care providers, researchers and activists as well as a representative from the WHO.  Each speaker will have 10 minutes and then two minutes for Q and A  Remainder of time for discusssion at the end.

5  Higher rates of employment, housing and educational discrimination  Avoidance of medical providers from fear of identity disclosure  Unique health care priorities (access to gender affirming healthcare)  High rates of transwomen working in the sex industry  Effect of changing physiology on HIV/STD prevention & risk reduction  Self-identification by gender identity, not sex assigned at birth

6  15countries including USA, six Asia-Pacific countries, five in Latin America, and three in Europe. N= 11,066 transgender women  HIV prevalence was 19·1%  The odds ratio for being infected with HIV compared with all adults of reproductive age across the countries was 48·8 (95% CI 21·2–76·3) and participants were;  Less likely to have access to and utilization of HIV services. 6 (Stefan D Baral, Tonia Poteat, et al; Lancet Infect Dis 2013; 13:214-22

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8 3% to 68% MTFs 0% to 2% FTMs North America 27.6% to 37.1 % South America 11.5% - 57% Europe 2% to 45.2% South Asia

9  Trans women disproportionately affected by HIV/AIDS  Stigma and discrimination impact access to services at every point in care continuum  Governments have been slow to respond  Global organizations can support efficacious responses that include a human rights framework.

10 JoAnne G. Keatley, MSW Email: joanne.keatley@ucsf.edu Tele: 415-597-4960 www.transhealth.ucsf.edu

11  Altaf, A; Zahidie, A. & Agha, A. (2012). Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study. BMC Public Health. E-pub ahead of print retrieved June 15, 2012 from http://www.biomedcentral.com/content/pdf/1471-2458-12- 279.pdf  Belza M, Llacer A, Mora R, de la Fuente L, Castilla J, Noguer I, & Canellas S. (2000) Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexual engaging in street prostitution. Gaceta Sanitaria, 14(5), 330-7.  Chakrapani, V.; Newman, P.; Shunmugam, M. & Dubrow, R. (2011). Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 23:12, 1687-1694.  Chariyalertsak, C.; Visarutratana, S. & Beyrer, C.(2011). HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men, and transgender persons in Northern Thailand. PLoS One, 6(9).  Chariyalertsak, S.; Kosachunhanan, N.; Saokhieo, P.; Songsupa, R.; Wongthanee, A.;  Etcheverry, M.F.; de Lazzari, E.; Fuchs, J.D.; Meroño, M.; Sierra, E.; Del Romero, J.; Evans, J.L.; Mendez-Arancibia, E.; Jacques, C.; Rojas, D.; Segú, M.; Gatell, J.M. & Joseph, J. (2010). Pilot study assessing HIV vaccine trial readiness among female sex workers, injection and non-injection drug users, and men who have sex with men in Spain. AIDS Behavior, 14 (3): 607-17.  Galli M, Esposito R, Antinori S, Cernushi M, Gianelli F, Cargnel A, Quirno T, Innocenti M, & Marozzi F. (1991) HIV-1 Infection, tuberculosis and syphillis in male transsexual prostitutes in Milan, Italy. Journal of Acquired Immune Deficiency Syndromes, 4(10), 1006-7.  Gattari P and Spizzichino L. (1992) Behavioural Patterns and HIV Infection Among Drug Using Transvestites Practicising Prostitution In Rome. AIDS Care, 4(1), 83-87.  Guadamuz, T.E.; Wimonsate, W.; Varangrat, A.; Phanuphak, P.; Jommaroeng, R.; McNicholl, J.M.; Mock, P.A.; Tappero, J.W. & van Griensven, F. (2011). HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand. AIDS Behavior. 2011 Apr;15(3):650-8.  Herbst, J., Jacobs, E., Finlayson, T., McKleroy, V., Neumann, M., & Crepaz, N. (2008). Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review. AIDS and Behavior 12 (1): 1–17.  Inciardi, J., Surratt, H., Telles, P., & Pok. B. (1999) Sex, Drugs, and the Culture of Travestismo in Rio de Janeiro. International Journal of Transgenderism, 3 (1+2) January-June 1999.  Khan A, Bokhari A, Nizamani N, Rehan N, & Khan A (2006) Differences in Sexual Behaviors of Male Commercial Sex Workers (MSWs) and Transgenders/Transvestites (Hijras) In Pakistan. Poster discussion: AIDS 2006 - XVI International AIDS Conference: Abstract no. TUPDD07"  Kumta S, Lurie M, Gogate A, Jerajani H, Weitzen S, Kavi A, Anand V, Makadon H, & Mayer K. (2006) Sexual risk behavior and HIV prevalence among male-to- female transgendered people seeking voluntary counseling and testing services in Mumbai, India. Oral abstract session: AIDS 2006 - XVI International AIDS Conference: Abstract no. MOAD0303.  Modan B, Goldschmidt R, Rubenstein E, Vonsover A, Zinn M, Golan R, Chetrit A, & Gottlieb-Stematzky T. (1992) Prevalence of HIV Antibodcies in Transsexual and Female Prostitutes. American Journal of Public Health, 82(4), 590-2.  Nemoto, T.; Iwamoto, M.; Perngparn, U.; Areesantichai, C.; Kamitani, E. & Sakata, M. (2012). HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care, 24(2):210-9.  Palwade P, Jerajani H, Ashok R, Shinde S, & Vivek A. (2004) Prevalence of HIV infection and sexually transmitted diseases amongst MSM population in Mumbai, India. CD Only: The XV International AIDS Conference: Abstract no. C10822.  Pisani E, Girault P, Gultom M, Sukartini N, Kumalawati J, Jazan S & Donegan, E. (2004) HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sexually Transmitted Infections 80(6): 536-40.  Ponnusamy A. (2006) Behavioral research / interventions. AIDS 2006 - XVI International AIDS Conference: Abstract no. CDC0968  Russi J, Serra M, Viñoles J, Pérez M, Ruchansky D, Alonso G, Sanchez J, Russell K, Montano S, Negrete M & Weissenbacher M. (2003). Sexual Transmission of Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Type 1 Infections among Male Transvestite Commercial Sex Workers in Montevideo, Uruguay. The American Journal Of Tropical Medicine and Hygiene 68(6), 716- 720.  Sahastrabuddhe, S.; Gupta, A.; Stuart, E.; Godbole, S.; Ghate, M.; Sahay, S.; Gangakhedkar, R; Risbud, A.; Divekar, A.; Bollinger, R. & Mehendale, S.M. (2012). Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India. Journal of Acquired Immune Deficiency Syndrome, 59 (1):72-8.  Silva-Santisteban, A.; Raymond, H. F.; Salazar, X.; Villayzan, J.; Leon, S.; McFarland, W. & Caceres, C. (2012). Understanding the HIV/AIDS Epidemic in Transgender Women of Lima, Peru: Results from a Sero-Epidemiologic Study Using Respondent Driven Sampling. AIDS Behavior 16:872–881  van Veen M, Hofhuis A, van der Helm T, Götz H, Prins M, & van de Laar M. (2006) Substantial risk behaviour among transgender sex workers in the Netherlands. AIDS 2006 - XVI International AIDS Conference: Abstract no. MOPE0478.  Varella, D., Tuason, L., Proffitt, M., Escaleria N, Alquezar, A., & Bukowski, R. (1996) HIV infection among Brazilian transvestites in a prison population. AIDS Patient Care and STDs 10(5): 299-302  Weitze C. & Osburg, S. (1996) Transsexualism in Germany: Empirical Data on Epidemiology and Application of the German Transsexuals’ Act During Its First Ten Years. Archives of Sexual Behavior, 25: 419.  Wimonsate W., Naorat S., Varangrat, A., Phanuphak, P., Kanggarnrua, K., McNicholl, J., Tappero, J., van Griensvn, F., Siraprapasiri, T., and the Thailand MSM Study Group (2005). Risk behavior, hormone use, surgical history and HIV infection among transgendered persons (TG) in Thailand, 2005. AIDS 2006 - XVI International AIDS Conference: Abstract no. MOPE0349  Zaccarelli M, Spizzichino L, Venezia S, Antinori A, & Gattari P, (2004) Changes in regular condom use among immigrant transsexuals attending a counseling and testing reference site in central Rome: a 12 year study. Sexually Transmitted Infections 80: 541-545.  Zehender, G., Colasante, C., de Maddalena, C., Bernini, F., Savasi, V., Persico, T., Merli, S., Ridolfo, A., Santambrogio, S., Moroni, M., & Galli, M. (2004). High prevalence of human t-lymphotropic virus type 1 (HTLV-1) in immigrant male-to-female transsexual sex workers with HIV-1 infection. Journal of Medical Virology, 74, 207–215.

12  How can we take full advantage of the multiple recommendations, instruments, guidelines and best practices that are being produced at all levels and ensure their sustained implementation?  What should be done to align health and social services for transgender persons with other existing initiatives, plans and programs?


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