In 2014, I asked San Francisco Health Commissioner (2012-present) Cecilia C. Chung for data on HIV transmission rates among transmen who identify as gay men. Cecilia Chung is regarded by many as the national authority on HIV/AIDS in the transgender community. Chung responded to my inquiry by passive-aggressively sending me a link to a list of all the demographic studies hosted by the San Francisco Department of Public Health website under ‘HIV /AIDS Programs and Research’.
By reviewing these studies I discovered that since 1996 the San Francisco Department of Public Health had been reclassifying all Transmen (Females who identify as male) diagnosed with HIV as Transwomen (Males who identify as female) for statistical purposes. When I pointed this out to Chung he refused to respond. Only after the exchange was re-tweeted by famous actor and comedian Roseanne Barr did Chung admit this to be so:
“You are correct. We have recently changed the method to capture the wide spectrum of gender identity and sex assigned at birth,” Chung finally replied.
However, an updated review of department materials indicates that this change was never implemented. Chung’s department continued to reclassify transmen as transwomen in their HIV statistics. Their most recent (2016) HIV Epidemiology Annual Report states [Page 97, Note on Transgender Status]:
In September 1996, SFDPH began noting transgender status when this information is contained in the medical record. Transgender individuals are listed as either male-to-female or female-to-male. The majority of transgender HIV cases are male-to-female (trans female). Due to the small number of trans male cases and potential small population size, their data are included with trans female cases to protect confidentiality.
[bolding by me. –GM]
Note how this reclassification of transmale HIV data was cited as being for their own good, nonsensically arguing that total erasure of AFAB transgender HIV data ‘protected their confidentiality’. Female HIV transmission rates among women who do not identify as transgender was not reclassified as male, nor was any heightened risk of potential confidentiality breech cited for non-transgender females. Only HIV data pertaining to transmen (women who identify as male) was deemed a risk to patient confidentiality. Only HIV data pertaining to transmen was deliberately erased.
More than one in ten transgender people living with HIV are transmen (identified as female at birth) reports a study released today in the American Journal of Public Health.
Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009–2014
Ansley Lemons MPH, Linda Beer PhD, Teresa Finlayson PhD, MPH, Donna Hubbard McCree PhD, MPH, RPh, Daniel Lentine MPH, and R. Luke Shouse MD, MPH, for the Medical Monitoring Project
The study looked at data starting in 2009 and ending in 2014, the same year I asked Cecilia Chung to stop reclassifying transmen as transwomen in official statistics.
AIDS Map reports:
“HIV-positive transgender men in the United States have significant unmet social and healthcare needs, according to a study published in Research and Practice. Approximately half were living in poverty and only 60% had sustained viral suppression.
“Many transgender men receiving HIV medical care in the United States face socioeconomic challenges and suboptimal health outcomes,” write the authors. “Although these transgender men had access to HIV medical care, many experienced poor health outcomes and unmet needs.”
Transgender people experience poorer health outcomes compared to cisgendered individuals (people whose current gender identity is the same as the one with which they were born).
Little is known about characteristics and outcomes of HIV-positive transgender men (designated female at birth). A team of investigators therefore analysed the records of patients who received HIV care in the United States between 2009 and 2014. Their aim was to characterise the sociodemographic and clinical characteristics of these patients.
Overall, transgender men constituted 0.16% of all adults but 11% of transgender adults receiving HIV care in the United States. The majority (59%) were aged between 18 to 49 years and 40% identified as gay or bisexual. Although 42% had completed high school, almost half (47%) had an income below the national poverty level. A third were uninsured or relied on a Ryan White programme for their health care. Over two-thirds (69%) had an unmet support need and a quarter were currently living with depression.
Most (53%) were sexually active.
The majority (57%) had been living with HIV for ten or more years; a quarter had a history of an AIDS diagnosis. The vast majority (93%) had ever taken antiretrovirals; 88% were on HIV therapy and 83% were fully adherent to their treatment. Last viral load measurement was undetectable in 69% and 57% had a current CD4 cell count above 500 cells/mm3. Two-thirds of patients had a viral load test every six months but only 40% had received sexual health or HIV prevention counselling from a healthcare professional.
“More than 1 in 10 transgender persons receiving HIV care were transgender men. HIV-positive transgender men receiving medical care in the United States constitute a small group with socioeconomic challenges, unmet needs for supportive services, and poor healthcomes,” conclude the authors. “To decrease disparities and achieve health equity among HIV-positive men, HIV care models could incorporate transgender-sensitive health care and mental health services and health insurance inclusive of sex reassignment procedures and physical sex-related care.”
[bolding by me. -GM]