French cohort of HIV transgender women highlights issues relating to HIV management
Simon Collins, HIV i-Base
In the UK there are currently no national data on the number of transgender people who are also HIV positive.
In fact, there are little data on any aspect of transgender health due to the lack of non-binary options on health records. But during 2016, a new NHS policy that will ask patients to include their current gender and their birth gender in medical records and to specify how they currently identify, is hoped to improve this.
Even with these policy changes, compiling data is complicated as it is dependent on self-identity and many transgender people no longer associate with their birth gender. In countries where data exist, the incidence of HIV in transgender people is often very high and engagement in care is often more complex. Although HIV treatment and management of transgender people is largely similar to people who retain the same gender in life as their birth gender (cis-gender people), there are a few important differences. These include potential drug interactions between ART and hormone treatment (including non-prescribed steroids), complications from surgery and health issues that relate to birth gender (ie cervical screening for trans men and AIN screening for trans women).
A poster at EACS 2015 presented data from a multicentre retrospective descriptive study of 47 transgender women in four university hospitals in northern France. Data was collected from a single anonymous questionnaire.
Mean age was 40 years (25 to 62). All respondents had a current or past history of sex work and 43/47 had been born in South America (32% said they did not speak French). All participants were on ART (more than half using a boosted PI) with a mean CD4 count of 608 cells/mm3 (60 to 1908) and approximately 70% had viral load <40 copies/mL.
All participants had a history of surgery, mainly mammoplasty, rhinoplasty and silicone injections, with 10/47 (21%) having undergone sex reassignment surgery. Just under half (46%) of the participants had current or previous use of hormone treatment.
The low rate of treatment for STIs compared to earlier French studies was explained by likely missing data. The study reported that only eight people had been treated for syphilis and three for urethritis. However, anal Pap smear results for 68% of the cohort included abnormalities in 70% of those tested, with one case of anal carcinoma.
A high incidence of comorbidities was similar to HIV cohorts. Cardiovascular risks included half being were current smokers and half had dyslipidaemia (details not presented) and 22/39 had BMI >25.
The poster noted multiple social and psychological issues including migrant status, multiple addiction and violence, in addition to gender identity and HIV. Hormone therapy was inconsistent in almost half the respondents. Two previous French studies were referenced for having reported good immunological and virological response to ART.
Having accurate data on transgender people is an essential step towards knowing whether the health needs and services for this population are being effectively delivered and met. The new NHS proposed policy that broadens information about gender options when accessing care is strongly welcomed. Sexual health centres areexpected to introduce this policy from spring 2016.
Last year the BHIVA conference included an overview talk on HIV and transgender patients that is available online as a webcast.  A review of transgender studies from the IAS 2014 conference is still relevant for many of the issues it covered. 
cliniQ is the UK’s only comprehensive sexual health and well-being clinic run by and for transgender people. cliniQ is a community service and is in Partnership with 56 Dean Street. 
- Leporrier J et al. Description of a male to female transgender HIV positive population in the North-West of France in 2013. Poster abstract 15/41.
- Radix A. HIV and vulnerable populations: transgender medicine. Invited lecture. 21st Annual Conference of the British HIV Association> 21–24 April 2015 Brighton.
- Collins S. HIV and transgender issues at AIDS 2014. HTB July/August 2014.
- cliniQ at 56 Dean Street clinic in Soho London.