The Transnational Cohort: global HIV epidemiology and prevention research for transwomen

Abstract

The Transnational Cohort (TC), enrolling participants in San Francisco and São Paulo, will test the hypotheses that social gender transition and lack of access to transgender-specific medical care cause or herald periods of elevated risk for HIV. The inferred period of high HIV incidence following youth coincides with many social gender transition events as well as successive hormonal therapy and surgical gender transition procedures. Our adult transwomen data show high sexual risk associated with breast augmentation, perhaps due to increased sexual partners as a result of greater gender conformity in appearance. The TC results will test the hypotheses that biomedical gender transition events cause or herald periods of elevated HIV risk or protective behaviors. Focusing in these events will help to identify targets for novel prevention interventions, for example, PrEP may be promoted for a limited time, or behavioral interventions can accompany medical and surgical procedures. The lack of transgender-specific medical care and the ability to socially transition may also cause high incidence of HIV and other adverse health effects. The Transnational Cohort will collect baseline information to map the positive and negative impact of social and biomedical transition events on HIV incidence, preventive behaviors, and other important health outcomes.