Characterizing HIV and STIs among Transgender Female Sex Workers: A Longitudinal Analysis

Abstract

ABSTRACTObjectivesThough highly vulnerable to HIV and STIs, transgender female sex workers (TFSW) are understudied in the U.S. HIV and STI response. This study examined the correlates of laboratory-confirmed STIs among a cohort of 62 TFSW followed over the course of one year and explored associations between specimen site and self-reported engagement in insertive and receptive anal intercourse.MethodsParticipants completed an interviewer-administered computer assisted personal interview at baseline, 3-, 6-, 9-, and 12-month visits where self-administered anal swabs and urine samples for gonorrhea, chlamydia, and trichomonas were also collected. HIV testing was conducted at baseline, 6-, and 12-month visits.ResultsBaseline HIV prevalence was 40.3% with no HIV seroconversions over follow-up. Baseline prevalence of gonorrhea, chlamydia, and trichomonas was 9.7%, 17.7%, and 14.5%, respectively. In the multivariable regression modeling, recent arrest was significantly associated with testing positive for any STI (aRR 1.77; 95% CI: 1.10-2.84). Insertive anal sex with clients was associated with increased risk of testing positive for an STI via urine specimen (RR 3.48; 95% CI: 1.14-10.62), while receptive anal sex was not significantly associated with specimen site.ConclusionOur findings confirm a high prevalence of STIs among TFSW and highlight the importance of addressing structural drivers such as criminal justice involvement as well as the need to ensure screening for STIs at all anatomical sites regardless of self-reported sites of potential exposure. More research is needed to better understand HIV and STI vulnerabilities and appropriate interventions for TFSW in the U.S.KEY MESSAGESTransgender female sex workers in the U.S. face substantial vulnerability to HIV and STIs, and interventions to reduce their risk for HIV and STI acquisition are needed.Engagement with criminal justice significantly increases the risk for STIs among transgender women engaged in street-based sex work, suggesting the need to address factors that lead to disproportionate arrest and incarceration of transgender women.Screening for STIs among transgender women should include all potential sites of exposure, regardless of reported sexual positioning.