Trans Rights, Sexual Health and HIV: The View from Canada

Presented by Dr Ayden Scheim, Division of Global Public Health, University of California, San Diego, USA 

Overview

1.       Trans populations are incredibly diverse

2.       Trans women disproportionately impacted by HIV globally

3.       A “global” picture obscures context & knowledge gaps

4.       Trans people face multi-level HIV /STI vulnerabilities and protective factors

5.       We must make trans people visible in HIV & sexual health

6.       A trans sexual health agenda is needed

Trans populations are diverse

Trans and gender diverse identities

-          Trans women/ trans feminine & trans men / trans masculine

-          Non- binary

-          Two Spirit

-          Sistergirl/ Brotherboy

0.6 % of US adults (~ 1 in 160) are trans gender compared 1.2 % of NZ high school students

Gender Identity

Non Binary people counted 35 %, while 33 % of Transgender women and 29 % of Transgender men with the least proportion is Crossdressers, only 3 %

Medical Transition (hormones and / or surgeries)

Almost a quarter already had completed transition and next quarter is still in process. Other half include; Planning but not begun, not planning to and not sure group as well as concept does not apply group

Ø  Trans women face a disproportionate HIV burden globally

-          Based on paper from Baral et al, Lancet Infectious Disease 2013, the pool HIV prevalence was 19.1 % in 11066 transgender women worldwide.

Trans men

Qualitative data is very limited and Lab confirmed HIV + varies from 0 - 4 % while self reported presented from 0 – 10 %

Choosing the right denominator

-          2/3 of trans men identify as gay, bi, queer but only 1/3 of those had sex with cis men

Trans MSM seem a lot like other MSM; however countervailing risk & protective factors shown as below are unavoidable

-          Sexual abuse, stimulant use, depression, syndemics predict risk behaviour

-          But are distinct in consequential ways

-          Exclusion from gay communities

-          Less anal intercourse

-          Changes to genital mucosa

Therefore, Trans people are not MSM….. except for when they are

-          Include trans MSM alongside other MSM

-          Who will be accountable to trans women ?

Summary

A trans sexual health agenda based in access to gender affirming care including hormones and surgery, reproductive care, HIV / STI prevention, screening and treatment in a context of gender recognition and rights protection