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Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013

Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013. Global Burden of HIV Trans Populations. Marginalized and Overlooked. Limits to Knowledge Base Routine health surveillance and monitoring of transgender populations globally is rare

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Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013

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  1. Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013 Global Burden of HIV Trans Populations

  2. Marginalized and Overlooked • Limits to Knowledge Base • Routine health surveillance and monitoring of transgender populations globally is rare • Transgender women historically included together men who have sex with men (MSM) in HIV surveillance • Transgender men are invisible • Result • Limited understanding of determinants of risk among transgender populations in most of the world

  3. Background Data • Operario et al 2008 • Pooled HIV prevalence: • 27.3% among trans women engaging in sex work • 14.7% trans women not engaging in sex work • Herbst et al 2008 • Pooled U.S. HIV prevalence: • 27.7% (range: 16% to 68%) (laboratory-confirmed)

  4. Systematic Review and Meta-Analysis

  5. Systematic Review: Inclusion Criteria • Published January 1, 2000 to November 30, 2011 • Languages: English, French, Spanish • Databases: PubMed, EMBASE, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine • Search terms • medical subject headings (MeSH) terms for HIV or AIDS, and terms associated with transgender ( transgender* OR “travesty” OR “koti” OR “hijra” OR “MTF” or “male to female transgender” OR transsexual* OR transvest* OR “mahuvahine” OR “mahu” OR “waria” OR katoey OR “cross dresser” OR “bantut” OR “nadleehi” OR “mahu” OR “berdache” OR “xanith”).

  6. Search Results 39 studies in 15 countries 11,066 transgender women

  7. Pooled Estimate of HIV Pooled estimate 19.1%

  8. Meta-Analysis of HIV Prevalence Data Odds Ratio = 49 (31.2, 76.3)

  9. HIV Among Trans Women by Income Level Baral et al., 2013

  10. Technical Report:The Global Health Needs of Transgender PopulationsA Review to Inform the President’s Emergency Plan for AIDS Relief (PEPFAR) Programming December 4, 2013 Stefan Baral, MD, MPH, FRCPC Sari Reisner, ScD, MA

  11. Research Synthesis - Methods • January 1, 2008 to May 28, 2013 • Pubmed, Embase, Ovid, Psychinfo, CINAHL PLUS, Web of Science, Sociological Abstracts, and Medadvocates (peer-reviewed) • WHO publications, National Library of Medicine’s Meeting Abstracts, New York Academy of Medicine- Grey Literature Report, FHI, PSI, Population Council, CDC, Public Health Agency of Canada, Pan American Health Organization, Google, WPATH, The Fenway Institute, AMSA, The Center of Excellence for Transgender Health, USAID, UNAIDS, UNDP, UNESCO, Columbia University, University of Hong Kong, AIDS Health Care Foundation, The Global Forum on MSM and HIV, Gay Lesbian Medical Association, The International HIV/AIDS Alliance, AEGIS Search, International AIDS Society (IAS), and JSI (non-peer reviewed grey literature) • English language • “Transgender” cross-referenced with terms for “Health” and “HIV” • common terms for “transgender” used around the world such as hijra, waria, etc. • terms similar to transgender such as travesti, transvestite, and trans man

  12. HIV in Trans Men • Data sources: • 13 peer-reviewed papers • 2 non-peer review needs assessments • HIV prevalence • 0% and 2.9% (2 laboratory-confirmed) • 0% to 10% (self-report) • Data only available from U.S. and Canada

  13. Conclusions • Trans women bear a very high burden of HIV infection in both low and high income countries • Studies only available from concentrated epidemics • No data available from SSA or EE/CA • Very scant data on HIV among trans men • Only 2 laboratory-confirmed studies • Trans MSM are increasingly visible - more data needed • We must explicitly include trans populations in HIV research and disaggregate the data in order to have relevant and actionable information

  14. “I was shocked at how hard it is to raise funds for a trans* organization.” “It’s very hard for us to identify funding organizations with criteria that we meet ... intersex isn’t on their list.” “We’re just not on funders’ radar.” “As we are “T” specific, it is difficult to access LGBT funding.”

  15. Number of Responding Groups per World Region

  16. Number of New Groups Founded 1985-2013, by Leadership Demographics

  17. Leadership Demographics of Groups

  18. Budget of Groups 2012 Budget (n=324) and 2013 Budget (n=338)

  19. Median Budget Size per Region

  20. Budget, Savings and Staffby Leadership Demographic

  21. Groups with Full-Time Staff Members (n=319)

  22. 2013 Funding Sources (n=335) Percentage of Groups that Received Funding from These Sources

  23. 2013 Funding Sources by Leadership

  24. Content of Current Work (n=340)

  25. Groups Would Like to Have Extra Funding for… (n=340)

  26. Non-Financial Support Desired Most (n=312)

  27. Skills Training Desired Most (n=311)

  28. Recommendations

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