Individuals who are transgender and receiving gender-affirming hormone therapy exhibit a 37% reduced likelihood of contracting HIV, and for those living with HIV, hormone therapy seems to provide a 44% lower probability of the virus being detectable in their blood, based on findings from a study by the University of Michigan.
Overall, the study indicated that hormone therapy for patients receiving medical treatment aimed at aligning their physical characteristics with their gender identity enhanced all HIV-related health outcomes for transgender, nonbinary, and gender diverse individuals.
The research, published in The Lancet HIV, analyzed health records of over 8,000 transgender and gender diverse patients who accessed primary care at community health centers in Boston and New York City between 2013 and 2019.
“The transgender communities have faced significant hardships due to the HIV epidemic. While the benefits of hormone therapy on mental well-being for transgender individuals are well-documented, there is less evidence regarding its impact on physical health issues like HIV. We sought to address this gap with our research,” stated Sari Reisner, the principal investigator and an associate professor of epidemiology at the U-M School of Public Health, who has recently published a study on hormone therapy and depression.
According to the World Health Organization, transgender individuals are approximately 13 times more likely to be HIV-positive compared to other adults of reproductive age. Simultaneously, WHO reports indicate that transgender individuals experience lower access to health services in comparison to the general populace, due to various challenges including violence, legal obstacles, stigma, discrimination, and socioeconomic disadvantage.
The researchers discovered that these obstacles likely contribute to elevated HIV rates among Black, Hispanic/Latino, and multiracial transgender populations compared to their white counterparts.
Moreover, the researchers found that a minimal number of participants—around 3% of those who were HIV-negative—were utilizing pre-exposure prophylaxis (PrEP), a medication designed for high-risk individuals, highlighting a significant chance to enhance HIV prevention initiatives.
“We possess public health resources to diminish HIV rates, including newer biomedical prevention methods like PrEP and traditional behavioral strategies such as advocating for condom use. However, HIV prevention and optimization of HIV care are not ‘one size fits all’ in public health,” emphasized Reisner. “We require customized approaches that take into account the lived experiences and needs of transgender individuals, such as integrated care models that merge gender care with HIV prevention and treatment services.”
The conclusions indicate that gender-affirming care serves as a public health measure that simultaneously meets multiple health needs. By administering gender-affirming hormone therapy, healthcare providers can not only support an individual’s gender identity but also potentially reduce HIV transmission and enhance treatment outcomes for a population experiencing considerable health inequities, according to the findings.
The research also demonstrated that patients who consistently remained engaged in care experienced improved health outcomes, with a specific correlation found between the duration of care engagement and effective management of the HIV virus or higher viral suppression rates.
Reisner, who also contributed a Perspective article in The Lancet HIV addressing the reasons for elevated HIV rates among transgender individuals, proposes solutions to tackle the various social, economic, and healthcare barriers that intensify HIV disparities. The article stresses the necessity for developing solutions in collaboration with transgender communities and advocates for increased research and funding aimed at understanding the needs of transgender individuals living with HIV.
“Trans communities are made susceptible to HIV. For transgender individuals, vulnerabilities and strengths regarding HIV are shaped by the multilevel and biopsychosocial contexts in which we exist,” Reisner indicated. “Public health cannot effectively counter the HIV epidemic unless we dismantle the interconnected systems of power and privilege associated with both gender and other marginalized identities, which contribute to HIV disparities.”
The research was supported by the Patient-Centered Research Outcomes Institute and the National Institutes of Health.