GLOBAL HEALTH NEEDS OF TRANSGENDER PEOPLE. Stefan Baral, MD MPH

GLOBAL HEALTH NEEDS OF TRANSGENDER PEOPLE Stefan Baral, MD MPH Acknowledgements    The transgender men and women across the world who particip...
Author: Magdalen Turner
22 downloads 0 Views 932KB Size
GLOBAL HEALTH NEEDS OF TRANSGENDER PEOPLE Stefan Baral, MD MPH

Acknowledgements 





The transgender men and women across the world who participate in these studies given significant risks and limited personal benefits The community groups that make great personal and professional sacrifices to serve the unmet health and advocacy needs of those most marginalized in the HIV response Contributions of Ideas and New Data 

Sari Reisner, Sam Winter, Tonia Poteat, Kevan Whylie, Claire Holland, Ashley Grosso, Paul Semugoma, Chris Beyrer, and others

Outline  

Health Issues Affecting Transgender People Conceptual Framework of Health Vulnerabilities among Transgender People  Structural



Determinants of Health

Health Care Interventions  Available

data  Mathematical Model   

Models of Care Delivery for Transgender People Moving Forward Key Themes

Transgender Global Disease Burden Systematic Review 2008-2014 

116 studies  30

countries  95 Definitions of Transgender Persons  981 health-related outcomes  Mental

health  Sexual and reproductive health  Substance use  Violence/victimization  Stigma and Discrimination  General Health

Transgender Health Research by Assigned Sex at Birth 60

Number of Data Points (n)

50

48

40

30 20

20

16 9

10

0

23

Male only

Female only

Male & Female (disaggregated)

Male & Female (not disaggregated)

Not specified

Assigned Sex at Birth

Reisner et al, Poteat, Baral., Lancet Special Issue, in press

Global Distribution of Transgender Health Research

Reisner et al, Poteat, Baral., Lancet Special Issue, in press

Population Studies Yielding Prevalence Data for Transgender People Author, Date, country

Sample

Conron, 2012, USA

28662 Adults

Glen and Hurrell, 2012, UK

Measure

Prevalence Data Birth Assigned Males (%)

Birth Assigned Females

All

Identification as Transgender

0.5

0.4

0.5

10039 Adults

Identification as other gender or in another way

0.6

0.4

0.5

Clark, 2014, New Zealand

8166 High School Students

Identification as transgender

1.3

1.2

1.2

Kuyper and Wijsen, 2014, Netherlands

8064 Adults

Identification gender spectrum

1.1

0.8

0.9

Van Caenergen, 2015, Belgium

1832 Adults

Identification gender spectrum

0.7

0.6

0.6

Winter, et al, Lancet Special Issue, in press

Global Health Burden: Six Health Outcome Categories in Transgender Health (n=981 Data Points), 2008-2014 8 350

Number of Data Points (n)

300

303

250 219 193

200 150

105 100

93 68

50 0

Mental Health

Sexual and Reproductive Health

Substance Use

Violence/ Victimization Health Outcome Category

Stigma/ Discrimination

General Health

Reisner et al, Poteat, Baral., Lancet Special Issue, in press

Burden of Mental Health among Transgender Youth 10



Percent (%)

 

Retrospective Cohort using EMR N=180, age 12-29, 2001-2010 Matches on multiple characteristics to non-transgender youth

60 Transgender Youth

Non-Transgender Youth

50 40 30 20 10 0

Depression

Anxiety

Suicide Ideation

Suicide Attempt

Mental Health (MH)

Self-Harm

Outpatient MH Services

Reisner et al., 2015 in J Adolescent Health

Inpatient MH Services

Burden of Mental Health among Transgender Youth

Reisner et al., 2015 in J Adolescent Health

Sexual and Reproductive Health Outcomes Puberty

Sex Work

Other (BV, PCOS, anal tear)

Viral Hepatitis

STI-related

HIV 0

Series1

10

20

30

HIV

STI-related

Viral Hepatitis

80

83

18

40

50

Other (BV, PCOS, anal tear) 5

60

70

80

Sex Work

Puberty

23

10

90

Reisner et al, Poteat, Baral., Lancet Special Issue, in press

HIV Prevalence among Transgender Women 2001-2011

Results 





The pooled global HIV prevalence was 19.1% (95% CI 17.4-20.7) In 7,197 transgender women from 10 LMIC, HIV prevalence was 17.7%(95%CI 15.6-19.8) In 3,869 transgender women from 5 HIC, HIV prevalence was 21.6%(95% CI 18.8-24.3)

HIV Prevalence Data among transgender women compared to all adults

Baral et al., Lancet Infectious Diseases, 2013

Burden of HIV among Transgender Women



Pooled OR for HIV infection among transgender women compared to other reproductive people 

48.8 (95% CI 31.2-76.3)

Source: Baral, et al. Worldwide Burden of HIV among Transgender Women The Lancet ID. 2013

Average HIV Prevalence Among Transgender Women by Region 50% 45% 40%

HIV Prevalence

35% 30% 25% 20% 15% 10% 5% 0%

North America (n=25)

Central and South America (n=6)

Africa (n=0)

Europe (n=3)

South and South East Asia (n=6)

Region (number of studies included)

Oceania (n=1) Multi-region (n=2)

Transgender Women across SubSaharan Africa 

Very rare for people to identify as transgender, but more common to identify as women using two-step gender assessment in studies focused on gay men and other men who have sex with men (MSM) 16% In Burkina Faso  19% In Malawi  25.5% in Swaziland (aOR for HIV 3.96 [1.66-9.43])  8% In Lesotho (p

Suggest Documents