A new study looks at demographic groups within the transgender community and finds that significant gaps exist.
Adrian Juarez, PhD, RN
A first-of-its-kind study of transgender individuals in western New York finds transgender women are more than 3 times as likely as transgender men to seek out HIV testing.
The study is preliminary and small in scale, however, it suggests significant disparities in testing participation among various demographic groups within the transgender community. For instance, transgender people who were black or Hispanic, and transgender people who had been incarcerated also had higher rates of HIV testing.
Adrian Juarez, PhD, RN, assistant professor in the University of Buffalo’s School of Nursing, told MD Magazine that the study grew out of his pre-doctoral work, which looked at how cultural and demographic variables can affect HIV testing experience. He found several population groups, including transgender patients, had higher rates of HIV testing, but didn’t seem to reap the health benefits.
“What I wanted to figure out was why did this population group have higher HIV testing rates, yet poorer HIV health outcomes,” he said.
The question is important because it complicates what could otherwise be seen as a simple prevention strategy.
“In the day of ‘seek, test, treat, and retain’ and discussions of HIV eradication, higher testing rates are supposed to lead to better HIV health outcomes,” he continued. “The trans-population group in my study did not experience any such improvements in their HIV outcomes.”
The study was based on data from the New York State AIDS Institute Reporting System from 2007 through 2013. Data were de-identified to ensure the privacy of the individuals involved. The researchers also conducted surveys with 27 transgender individuals, 23 of whom were trans women.
The study was focused geographically on western New York, which Juarez said is an important distinction. Most of the limited research to date on the topic of transgender health focuses on major metropolitan areas, whereas Juarez’s research more specifically captures the current situation in the cities of the Rust Belt.
Juarez’s study found that perceived risk of HIV infection and access to healthcare and testing correlated significantly with higher rates of HIV testing. He argues that targeted testing outreach is needed to help groups of people at higher risk, such as people who are incarcerated and people in residential substance-abuse treatment facilities.
Participation in or access to support groups also played a role in the likelihood that a patient would get tested. In an indirect way, that might be one reason trans women are more likely than trans men to be tested, Juarez said.
“I think much of this discrepancies between trans men and trans women are seen because of the organization and advocacy found in trans women community-based groups,” he said. “A majority of individuals in these groups are trans women and a very small number of trans men.”
Juarez said providers who specifically seek to work with transgender patients often use these same community-based groups to locate and deliver testing, thus resulting in the same discrepancies, Juarez said.
When asked what the takeaway should be for healthcare providers who treat transgender patients, Juarez was clear and concise.
“Test everyone, regardless of risk or history,” he said. “Also, don’t mis-gender your patients.”
The study, "HIV Testing in Urban Transgender Individuals: A Descriptive Study" was published in Transgender Health and can be read in full at this link.