Colleen Kelley

Transgender individuals, particularly transgender women (TGW), represent an underserved and highly stigmatized group in clinical HIV prevention and care as well as research. Clinical care and research must be tailored to meet the needs of TG populations; this session highlighted best practices from successful care models in diverse global settings.

TG people must be counted, ideally with a two-step system that queries sex assigned at birth and current gender identity, to truly understand the barriers to care. ‘Context is everything,’ stated Dr. Veras from Brazil where legal protection for LGBTQ people exists yet high rates of violence and discrimination against TGW driven by stigma persist. Data from Catalonia, Spain were presented describing HIV/STI vulnerabilities among the TG population. Data from the Trans*National Cohort showed that even in trans-friendly San Francisco where gender affirming hormone therapy and surgery are accessible, high rates of HIV, unstable housing, mental distress, and poverty persist. The Tangerine Community Clinic in Bangkok is a model for integrating co-located gender affirming medical care with sexual health services, all led by TG staff, to abrogate stigma and discrimination in health care. Personal stories of TG resiliency in the face of great challenges are powerful testimony to future possibilities.

Important progress, highlighted in this session, is being made in some places to serve the health care needs of TG people, including sexual health needs. Nonetheless, the unbelievable challenges facing TG people in health care must be addressed globally. Creation of a non-judgmental and accepting environments to reduce stigma is critical to successful gender-affirming health care programs. Co-location of hormone therapy is an essential part of trans-friendly services. Nonetheless, without addressing the structural discrimination that contributes to homelessness, violence, and extreme marginalization, significant improvements will not be achieved.

Arantxa Colchero

The session presented an overview of studies on transwomen surveyed in cross sectional or longitudinal data or engaged in health care services from a variety of countries and settings. All studies show different data related to the vulnerability and the need to create services according to their needs.

Transwomen are not distinguished in surveillance data. Cross sectional and longitudinal studies such as those shown by Jordi Casabona (Catalonia) and Erin Wilson (San Francisco) provide valuable information on the sociodemographic profiles, HIV prevalence and access to care. All studies presented in this session showed high rates of HIV prevalence (from 22% to 40%) and high incidence. Similarly, all studies highlighted high levels of stigma and discrimination, low access to health care, low socioeconomic status. Efforts to provide care based on transwomen needs were illustrated by Erin Wilson in clinics in San Francisco and by Reshmie Ramautarsing at the Tangerine Clinic in Thailand. Presentations from Brazil (Maria Veras) and from Thailand Reshmie Ramautarsing) illustrated the low PreP uptake related to high messaging on MSM only, low risk perception of HIV and concerned about drug interactions among transwomen.

The session addressed relevant issues related to transwomen in very different countries and settings. Despite the different contexts, similarities in terms of HIV prevalence, low access to care and social vulnerability are notorious. Future studies should explore factors associated with low uptake of PrEP and novel strategies to reach and engage transwomen in health care.

Ines Aristegui

This session covers the situation of transgender people in different countries, such as Spain, Brasil, Mexico, Thailand and United States, as well as different strategies implemented to face the high prevalence of HIV in this population.

The situation of transgender people was very similar around the world. Even in countries with universal access to care and very progressive laws in terms of health, transgender people present poor health outcomes and face syndemic factors like, low levels of education, unstable housing, violence, gender-related stigma and substance use. Although there is high awareness of PreP among this population, the percentage of people in PreP is very low and adherence is even lower. Gender-affirmation was consistently presented as the entry point to healthcare system and as a manner to counteract stigma. The one-stop shop strategy as the most adequate for this population’ needs. The Tangerine Clinic from Thailand, is an example of good practices. It’s a Transgender-led, hormone-integrated sexual health clinic. It provides and intervenes at different levels, and in an integral manner: ITS testing and treatment, mental health services, sexual health, and well-being.

At the end of the session, there was a debate about the need of transgender people to talk for themselves, considering the title of the session, and the existence of several transgender researchers that can do that work. This also brought a discussion about the inequalities among countries, as in the majority, it is difficult to count with transgender researchers and professional. The need to train the community and to offer study opportunities was highly demanded. Another claim was that the only transgender person in the panel, had no translation, making her even more invisible.