Identifying and Characterizing Trans women in the Swiss HIV Cohort Study as an Epidemiologically Distinct Risk Group.

Nguyen, Huyen; Hampel, Benjamin; Nuñez, David Garcia; Battegay, Manuel; Hachfeld, Anna; Bernasconi, Enos; Calmy, Alexandra; Cavassini, Matthias; Vernazza, Pietro; Fellay, Jacques; Rudolph, Hannes; Huber, Michael; Leuzinger, Karoline; Perreau, Matthieu; Scherrer, Alexandra; Ramette, Alban Nicolas; Yerly, Sabine; Günthard, Huldrych F; Kouyos, Roger D and Kusejko, Katharina (2022). Identifying and Characterizing Trans women in the Swiss HIV Cohort Study as an Epidemiologically Distinct Risk Group. Clinical infectious diseases, 74(8), pp. 1468-1475. Oxford University Press 10.1093/cid/ciab628

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BACKGROUND

As trans women are disproportionately affected by the HIV epidemic, and are still understudied, we aimed to identify and characterize the trans women in the Swiss HIV Cohort Study (SHCS).

METHODS

A combination of criteria from pre-existing cohort data was used to identify trans women. Information on socioeconomic factors, clinical data, risk behaviors, and mental health was collected. We also described their phylogenetic patterns within HIV transmission networks in relation to other risk groups.

RESULTS

We identified 89 trans women out of a total 20925 cohort participants. Trans women were much more likely to be Asian (30.3%) and Hispanic (15.7%) compared to men-who-have-sex with-men/MSM (2.5% and 4.1%, P value<0.001) and cis heterosexual (HET) women (7.0% and 3.3%, P value<0.001). Trans women were more similar to cis HET women in some measures like education level (post-secondary education attainment: 22.6% and 20.7% [P value =0.574], vs. 46.5% for MSM [P value<0.001]), while being more similar to MSM for measures like prior syphilis diagnosis (36.0% and 44.0% [P value=0.170], vs. 6.7% for cis HET women [P value <0.001]). 11.2% of trans women have been priorly hospitalized for psychological reasons, compared to 4.2% of MSM (P value=0.004) and 5.1% of cis HET women (P value=0.025). An analysis of transmission clusters containing trans women suggested greater affinity within the transmission networks to MSM compared to cis HET women.

CONCLUSIONS

Trans women are epidemiologically distinct in the setting of the Swiss HIV epidemic, warranting better identification and study to better serve this underserved risk group.

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