Gender Identity
“Transgender” is an umbrella term used to describe people whose gender identity and/or expression does not conform to norms and expectations associated with the sex that they were assigned at birth. Transgender clients may identify as genderqueer, gender
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Introduction “Transgender” is an umbrella term used to describe people whose gender identity and/or expression does not conform to norms and expectations associated with the sex that they were assigned at birth. Transgender clients may identify as genderqueer, gender variant, gender non-conforming, FTM, MTF, transmasculine, transsexual, or any of the above terms.
HIV and Transgender Populations Research on HIV infection and transgender populations has been scant, with much of the literature focusing on transgender women or MTF (male to female) transgender individuals. Transgender men (FTMs), particularly those who have sex with non-transgender men, are also at risk for HIV and STI infection; the current state of prevention and outreach is inadequate for this population, as well as for people who identify as gender non-conforming or gender variant. While trans women tend to report the highest level of HIV risk and other adverse health outcomes relative to other transgender populations and prevalence of HIV infection among transgender men is very low, it is important to recognize that their prevention needs are not being met and to think about creative ways to find solutions to this issue. Studies show that transgender women are more likely than transgender men and nontransgender men and women to engage in sex work. Risk factors for HIV and other STIs among the population of transgender people engaging in sex work include forced sex or coercion from clients, injection drug use, unprotected sex H. Wollin (*) School of Social Work, University of Southern California, Los Angeles, CA, USA e-mail: [email protected] S. Loue (ed.), Mental Health Practitioner’s Guide to HIV/AIDS, 219 DOI 10.1007/978-1-4614-5283-6_40, # Springer Science+Business Media New York 2013
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for financial incentives, or sharing needles when using street market hormones. Transgender women are also less likely to report 90% ART adherence and to report less confidence in their abilities to incorporate treatment regimens in their daily lives. Despite low prevalence rates among transgender men, some do engage in unprotected sex with non-transgender men, participate in sex work, and share needles while using injection drugs or hormones. There is virtually no research on HIV risk among people who identify as genderqueer or gender variant.
Mental Health Issues Transgender people disproportionately face systemic issues like discrimination, harassment, poverty, and lack of access to medical care. Transgender people, like lesbian, gay, and bisexual people, may be at greater risk for mental health issues such as depression, anxiety, PTSD, and co-occurring substance abuse disorders. A diagnosis of HIV is also often correlated with depression and other mental health issues. It is important for providers to screen clients for these issues as they may go unseen and unnoticed.
Recommendations for Clinicians Clinicians who are working with gender variant or transgender clients must foremost take on the responsibility of educating themselves a
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