More than ten years ago, psychologist and researcher Jae Sevelius had an idea: the behavior that transgender people could place at very high The risk of getting HIV comes from the fact that their gender was not confirmed as they needed.
If that could happen more easily for people – with good medical care, but also through validation of family, friends and society – they would generally be healthier and less inclined to perform risky behavior that could endanger them in an HIV Gender mounting framework.
A study of more than 8,000 trans- and non -binary people who were published on Thursday in The Lancet HIV Supports this idea. In two prominent LGBTQ+ Community Health Centers in the US, patients who received gender -confirming hormones were 37% less likely to be infected with HIV than those who did not take hormones. And if they were already infected, they were 44% less likely to have transferable levels of the virus in their blood.
“This has been a strong hypothesis for a while,” says Diana Tordoff, an epidemiologist at Stanford University focused on LGBTQ+ Health Equity, who was not involved in the study. “It is really nice to see a very thoughtful, well -done study that confirms this, with a pretty significant effect size.”
It is a critical confirmation, arriving at a time when both research and clinical care for transgender people is impeded by the government action that denies variations in sex, attempts to drastically invest the access of young people to care, the inclusion of transitional identities in federal health surveillance data in the end of LGBTQ+ Health subsidies.
“It’s a very difficult time. We have to do this research more than ever,” said Study author Sari Reisner, a social and psychiatric epidemiologist at the University of Michigan School of Public Health.
Even before the Trump government took over, there has long been a sub -investment in Trans Health, Reisner said. Data on Transmensen and HIV are limited, usually aimed at transgender women, with little longitudinal data.
The new study includes 2013 to 2019, after patients with a diverse range of gender identities and racial backgrounds in Callen-Lorde Community Health Center in New York and Fenway Health in Boston. Black, Spanish and Multiracial Trans -participants had disproportionately high percentages of HIV, the authors of which were the hypothesis related to structural barriers such as a lower social -economic status.
These two centers specialize in providing gender -confirming care and treating LGBTQ+ people who call the authors as a restriction on the study. Repeating the study in less specialized clinics would probably not change the results, but it would be a more difficult study to conduct, said Kellan Baker, the executive director of the Institute for Health Research and Policy at Whitman-Walker. (Baker was part of early discussions that the cohort study took off the ground, but did not participate further.) First, it requires a level of trust between patients and their clinics. From a logistics, it requires electronic medical records that can record information about gender identity and trained staff who can talk about hormones and HIV prevention.
This is the second paper that pulled out of this cohort with the benefits of hormones. Earlier in March, Reisner and colleagues showed that patients who took hormones had a much lower risk of experiencing moderate to severe depressive symptoms than not on hormones.
Neither of the study is investigating why the associations took place. In addition to exploring those mechanics in a future study, Reisner also wants to look at how social, psychological and legal dimensions of gender statement influence the HIV risk in transmensens.
Among the participants, only 3.1% without HIV had a current recipe for prophylaxis before exposure (prep). That is “surprisingly low,” said Reisner. He would also like to study the inclusion of this effective, preventive medication among trans communities and whether it has increased over time.
But pursuing new studies will be a challenge. Like many researchers, Reisner has lost all his existing subsidies from the National Institutes of Health. While the team that worked on this study still pursues other publications based on the cohort, the future is then cloudy.
Returning to the framework for gender confirmation, experts are concerned that the same forces that make research more difficult will also have serious effects on the health of transgender people.
“The administration and policy cannot delete transgender people,” said Baker. “They can make their lives a lot harder. And in the context of HIV prevention and treatment, the policy of this administration can kill people.”