Luzzati R.

Maurel C.

Pavan N.

Trombetta C.

Zatta M.

English

Archivio istituzionale della ricerca - Università di Palermo

LETTER TO THE EDITORDownloaded from http://journals.lww.com/stdjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 11/02/2024Human ImmunodeficiencyVirus and SexuallyTransmitted DiseaseDisparities AmongTransgender PersonsTo the Editor:W e read with interest the editorial ofClare Barrington on our recent article,evaluating the prevalence of Human Immu-nodeficiency Virus, Hepatitis B Virus, andHepatitis C Virus Infections Among Trans-gender Persons Referred to an Italian Cen-ter for Total Sex Reassignment Surgery.1,2We would like to comment on the roleof health assistance disparities for trans-gender people worldwide. Experiences oftransphobic discrimination and victimiza-tion negatively impact on mental health, andthe lack of social support has been foundto be associated with a higher rate of un-diagnosed human immunodeficiency virus(HIV) infection.3 To accurately assess theprevalence of HIV infection and of othersexually transmitted diseases (STDs) in thetransgender population, it is essential tocreate centers that can offer a comprehen-sive, multidisciplinary, and adequate supportto these patients. The Italian experience ofOsservatorio Nazionale sull’Identità di Genere(national observatory for gender identity;www.onig.it) is an example of cooperationof 7 centers for the diagnosis, support andhealth care of transgender people. Unfortu-nately, Osservatorio Nazionale sull’Identitàdi Genere is especially addressed to the peo-ple who intend to undergo sex reassignmentsurgery (SRS) and therefore a part of trans-gender individuals who give up on surgery780Copyright © 2016 by the American Sexually Tis not assisted in this setting. Indeed, thistransgender population might miss impor-tant healthcare issues including those relatedto STDs.We agree with Barrington that it isimportant to understand the fluidity in iden-tities among transgender patients. However,because of this fluidity it is difficult to in-clude this population in strict categories re-quired by statistical analysis. A recurrentproblem in the data collection systems isthe way in which we collect and reportdata related to sex and gender, which isoften incomplete or too simplistic. Thesedifficulties could in part explain why weconsidered in our study only a specificsubpopulation patients undergoing SRS.Namely, we found the comparison withother studies seldom reliable due to thelack of uniformity in the transgender pop-ulation samples. In our opinion, there arealso major ethical issues that hinder anobjective classification.Barrington mentions the Wilson andcolleagues study4 showing that users of SRSservices were found to have significantlylower estimated odds of suicidal ideationand risky behaviors. In our study, a youngerage at SRS would appear to be protectiveagainst HIV infection. This suggests thataccess to the SRS can reduce the inci-dence of risky behavior and thus long-termconsequences on mental and physical healthof these people. To strengthen this evidence,we are performing a prospective study thatcorrelates potentially risky behaviors, andphysical and mental health indicators in-cluding STDs.Finally, we would also like to makeclear that HIV preexposure prophylaxis isstill not offered free of charge in Italy as wellas in the majority of countries worldwide.Sexually Transmitted Diseases •ransmitted Diseases Association. UnauthorizTherefore, few people have access to it,and this practice is extremely underused.We would recommend it especially to trans-gender sex workers who might be more fre-quently in the condition to have to discuss ornegotiate condom use.Roberto Luzzati, MDCristina Maurel, MDInfectious Diseases UnitUniversity Hospital of TriesteTrieste, ItalyNicola Pavan, MDMarta Zatta, MDCarlo Trombetta, MDDepartment of UrologyUniversity Hospital of TriesteTrieste, ItalyREFERENCES1. Barrington C. Understanding and addressinghuman immunodeficiency virus and sexuallytransmitted disease disparities among trans-gender persons. Sex Transm Dis 2016; 43:412–413.2. Luzzati R, Zatta M, Pavan N, et al. Prevalenceof human immunodeficiency virus, hepatitis Bvirus, and hepatitis C virus infections amongtransgender persons referred to an Italiancenter for total sex reassignment surgery.Sex Transm Dis 2016; 43:407–411.3. Sevelius JM, Keatley J, Gutierrez-Mock L.HIV/AIDS programming in the United States:considerations affecting transgender women andgirls. Womens Health Issues 2011; 21(6 Suppl):S278–S282.4. Wilson EC, Chen YH, Arayasirikul S, et al.Connecting the dots: examining transgenderwomen's utilization of transition-related medi-cal care and associations with mental health,substance use, and HIV. J Urban Health2015; 92:182–192.Volume 43, Number 12, December 2016ed reproduction of this article is prohibited.

Human immunodeficiency virus and sexually transmitted disease disparities among transgender persons

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Human immunodeficiency virus and sexually transmitted disease disparities among transgender persons

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