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

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.