Health Report

Trans People & H.I.V.

A brief summary of Camille Finks' report on the Transgender Community Health Project's (T.C.H.P.) study as reported in F.T.M. Newsletter, Issue 45, Summer 1999, F.T.M. International.

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

Findings Summary

In February of this year (1999) at a community meeting in San Francisco's Tenderloin district, the Transgender Community Health Project (T.C.H.P.) of the city's Public Health Department presented the findings of its groundbreaking study of H.I.V. risk among M.T.F. and F.T.M. transgendered individuals in the Bay Area. The T.C.H.P. had also previously made a formal presentation of it's findings to the Federal Centre for Disease Control in Atlanta.

A staff of transgendered interviewers spoke with 123 F.T.M. and 392 M.T.F. participants from July to December 1997. Socio-demographic information as well as data regarding medical history and health status, H.I.V. prevention service access, sexual behaviours, drug use behaviours and psychosocial factors were collected. Respondents were tested for H.I.V. and received H.I.V. / S.T.D. counselling, harm reduction counselling and referrals. The study specifically sought to "sample a large number of transgendered persons who typically are not eligible for studies or are excluded from analysis because their gender does not fit the male/female dichotomy."

F.T.M. sample was 67% white, about 10% each Latino, African-American and Asian-Pacific Islander and 3% Native American. M.T.F. sample was 27% each white, Latino, and African-American and 13% Asian-Pacific Islander and 6% Native American. Both groups had a median age of around 35, with the F.T.M. group having a higher median income, higher rates of private health insurance, lower rates of past incarceration, and radically lower rates of H.I.V. infection.

While 80% of the F.T.M.s had jobs, stable housing and at least some college education, 40% of the M.T.F.s were homeless or in unstable housing and more than half the M.T.F.s interviewed had a high school education or less.

30-50% of both groups had high rates of S.T.D. diagnosis, and similar numbers had had mental health conditions resulting in prescribed medication. About 30% of both groups reported suicide attempts.

Hormones / Surgery

Of F.T.M.s: over half reported hormone use with one-third undergoing sexual reassignment or gender confirmation surgery and some 85% indicated they planned to have surgery.

Of M.T.F.s: 91% used hormones with 22% undergoing some type of surgery and 72% planned to have surgery in the future.

Abuse / Discrimination

All F.T.M. respondents reported experiencing "some form of discrimination or abuse related to gender presentation or gender identity".

M.T.F.s also reported similarly high incidences of discrimination and abuse, with 37% experiencing recent physical abuse.

Sexual Practices

Among both F.T.M. and M.T.F. respondents, 59% reported a history of forced sex or rape. The rates of unprotected sex amongst F.T.M.s was 28% unsafe anal intercourse with 64% having unprotected vaginal intercourse.

The rates of unprotected sex amongst M.T.F.s ranged between 64% - 85% for unprotected anal sex with 6% engaging in unprotected vaginal intercourse.

The issue of low self-esteem and unprotected sex was significant for both F.T.M. and M.T.F. participants.

Drugs and Alcohol

The study indicated that 23% of F.T.M.s had a history of participation in an alcohol treatment program and one-fifth in a drug treatment program. About 18% of F.T.M.s surveyed reported lifetime injection drug use - most commonly speed, heroin, and cocaine - and a very high number of these individuals shared syringes (91%).

18% of M.T.F.s reported recent injecting drug use.

H.I.V. Rates

The study found an alarming H.I.V. prevalence among M.T.F. participants with over two-thirds of this group testing positive for the H.I.V. virus.

Participants of the qualitative study who were living with H.I.V. felt that the transgender individuals need more client advocacy and case management, particularly in terms of health care.

Conclusions

Researchers commented that the reports of unprotected anal sex and needle sharing suggest that F.T.M.s who have sex with men, and those who inject drugs may be at risk for H.I.V. and should be targeted during outreach. For M.T.F.s, the data indicate that histories of sex work, unprotected anal sex and injection drug use together with a high level of recent risk behaviours "suggest continued transmission of H.I.V. among M.T.F. individuals and their sexual and drug using patterns."

Dion Manley and Jed Bell, writers for the F.T.M. Newsletter (Issue 45, Summer 1999), state two concerns with the conclusions reached within the T.C.H.P.s findings.

"(1) The class and race breakdowns of F.T.M.s differ so vastly from those of M.T.F.s in the study, that we believe they cannot simply reflect an objective difference in the two populations.

Instead, we believe this difference must also reflect the different ways available in the investigating staff for reaching F.T.M.s and M.T.F.s. Both populations were sought out in the street and community settings. But our speculation is that most F.T.M.s were actually reached through organisations, meetings and community events, while most M.T.F.s were contacted through street outreach and social service programs. While this difference reflects real contrasts in our lives and in how M.T.F.s and F.T.M.s can be contacted in this city, it may not reflect such vast differences in the overall transgendered populations.

(2) Even without this issue and place, we neither understand nor agree with the T.C.H.P.s conclusion that F.T.M.s are at low risk for H.I.V.. F.T.M.s frequently engage in high-risk behaviours, according to the report (see "Sexual Practices" and "H.I.V. / AIDS: Some Issues for F.T.M.s" by Ms. Vivianne K. Namaste, Ph.D.).

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