WP 84 Incidence of Sexually Transmitted Diseases Among Transgender Persons with HIV, New York City, 2000-2010

Tuesday, June 10, 2014
International Ballroom
Preeti Pathela, DrPH, MPH, Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY, Sarah Braunstein, PhD, MPH, HIV Epidemiology and Field Services, New York City Department of Health and Mental Hygiene, Long Island City, NY, Colin Shepard, MD, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY and Julia Schillinger, MD, MSc, Bureau of Sexually Transmitted Disease Control, NYC Department of Health & Mental Hygiene, Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Queens, NY

Background: Transgender women (TGW: born male, express female gender identity) are at high risk for HIV, but have been less well studied than other biologically-born men-who-have-sex-with-men (MSM). Sexually transmitted diseases (STD) among HIV-infected persons signal ongoing risk behavior and potential for secondary HIV transmission. We present population-level estimates of STD incidence among HIV-positive TGW.

Methods: Retrospective cohort analysis of STD incidence among TGW using data from a match of NYC’s HIV and STD surveillance registries (232,295 HIV/AIDS cases reported through 3/31/2011; 618,597 STD cases from 1/1/2000-6/30/2010). Our analytic cohort comprised all 345 TGW diagnosed with HIV during 1/1/2000-6/30/2009. TGW were followed until first incident STD (chlamydia, gonorrhea, early syphilis), death, or end of follow-up (6/30/2010). STD were considered incident if diagnosed ≥14 days after HIV diagnosis, plus a disease-specific incubation period. TGW STD incidence was compared to that of non-transgender MSM.

Results: Of TGW, 90% were black or Hispanic. Cohort participants contributed 1,821 person-years of observation (median: 5.15 years). Forty-nine (14.2%) had an incident STD; overall STD incidence was 2.7/100 PY. Median time to STD was 2.3 years; 14.3% of STD were diagnosed <6 months after HIV diagnosis. Incidence did not vary by race/ethnicity but was higher among TGW diagnosed with HIV before age 19 (5.3/100 PY, versus 1.2/100 PY in those >30 years) and those HIV-positive for <5 years (8.0/100 PY versus 0.68/100 PY in TGW with HIV >5 years). STD incidence did not differ by whether TGW were in HIV care within 3 months of HIV diagnosis (3.48/100 PY, versus 2.26/100 PY among those not in care by 3 months). Incidence among non-transgender MSM was 4.1/100 PY.

Conclusions: We documented substantial risk of incident STD following HIV diagnosis in a large cohort of TGW. Findings underscore the need for frequent STD screening and prevention counseling in this population.