Prevalence of HIV and STD's in a Dutch transgender population: TITAN-study

According to the World Health Organization (WHO), transgender people are part
of the five key populations at high risk for contracting HIV (1). This is
partly due to their vulnerable social position and biomedical risk factors such
as injecting substances, sharing injection equipment, higher prevalence of
commercial sex work, and higher levels of substance abuse compared to the
general population, as well as violence and lack of family support (1)(2)(3).
In a recent meta-analysis conducted in the United States, an average HIV
prevalence of 27.7% was determined among transgender women( people assigned
male sex at birth who identify as women), in contrast to an average
self-reported HIV prevalence of 11.8% (4). This indicates that many transgender
women might not be aware of their HIV-status and miss the opportunity for
timely treatment, and therefore could play a role in the further dissemination
of HIV (2). According to some studies, transgender women are also more
vulnerable to contract HIV and bacterial STDs (sexually transmitted diseases)
than cisgender MSMs, who are widely recognized as a population
disproportionately affected by HIV and STDs(11-13). Moreover, less is known
about HIV and STD risk among transgender men (people assigned female sex at
birth who identify as men). Evidence suggests that transgender men who have sex
with cisgender men (men whose gender identity match their sex assigned at
birth) represent an important subgroup with higher HIV risk (9,10).

In the Netherlands and Western Europe, epidemiological data on HIV and STDs
among transgender people is scarce. Furthermore, there are no detailed
intervention programs yet available for this specific population in terms of
prevention (5). To design HIV behavioral interventions targeted at all
transgender people, accurate and complete epidemiological data is needed
(6).

The aim of this study is to gain insight into the prevalence of HIV and other
STDs among transgender people. In addition, we want to identify determinants
that are associated with HIV and STD contraction (through optional
questionnaires). The ultimate goal is to provide high quality and
gender-affirmative care for the prevention of HIV and STDs in this vulnerable
population.

1)to gain insight into the prevalence of HIV and other STDs among transgender
people.
2) to identify determinants that are associated with HIV and STD presence
(through optional questionnaires).

Cross-sectional cohort study

The burden that the participants may experience is taking the time to fill out
the questionnaire (will take approximately 30 minutes). Also, peripheral blood
(4.5ml) and swabs (anal, pharyngeal or vaginal), and samples of urine will be
obtained once at a routine visit. We try to reduce this burden by instructing
the subject on how to take the swab tests themselves. The associated risks and
benefits are negligible. The advantages of study participation are that
subjects might get a timely HIV or STD diagnosis. Earlier studies have shown
that, for particularly HIV, earlier treatment is better for the outcome. The
disadvantages are that the subject might find a positive HIV or STD test result
stressful. Furthermore, subjects may feel uncomfortable with taking swab tests.