Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK.
Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
HIV Med. 2021 Feb;22(2):131-139. doi: 10.1111/hiv.12987. Epub 2020 Oct 26.
We provide the first estimate of HIV prevalence among trans and gender-diverse people living in England and compare outcomes of people living with HIV according to gender identity.
We analysed a comprehensive national HIV cohort and a nationally representative self-reported survey of people accessing HIV care in England (Positive Voices). Gender identity was recorded using a two-step question co-designed with community members and civil society. Responses were validated by clinic follow-up and/or self-report. Population estimates were obtained from national government offices.
In 2017, HIV prevalence among trans and gender-diverse people was estimated at 0.46-4.78 per 1000, compared with 1.7 (95% credible interval: 1.6-1.7) in the general population. Of 94 885 people living with diagnosed HIV in England, 178 (0.19%) identified as trans or gender-diverse. Compared with cisgender people, trans and gender-diverse people were more likely to be London residents (57% vs. 43%), younger (median age 42 vs. 46 years), of white ethnicity (61% vs. 52%), under psychiatric care (11% vs. 4%), to report problems with self-care (37% vs. 13%), and to have been refused or delayed healthcare (23% vs. 11%). Antiretroviral uptake and viral suppression were high in both groups.
HIV prevalence among trans and gender-diverse people living in England is relatively low compared with international estimates. Furthermore, no inequalities were observed with regard to HIV care. Nevertheless, trans and gender-diverse people with HIV report poorer mental health and higher levels of discrimination compared with cisgender people.
我们提供了英格兰跨性别和性别多样化人群中艾滋病毒流行率的首次估计，并根据性别认同比较了艾滋病毒感染者的结局。
我们分析了一个全面的国家艾滋病毒队列和英格兰艾滋病毒护理人群的全国代表性自我报告调查（积极声音）。性别认同使用与社区成员和民间社会共同设计的两步问题进行记录。通过诊所随访和/或自我报告对答复进行了验证。人口估计数取自国家政府办公室。
2017 年，跨性别和性别多样化人群中的艾滋病毒流行率估计为每 1000 人 0.46-4.78，而普通人群为 1.7（95%可信区间：1.6-1.7）。在英格兰，94885 名确诊患有艾滋病毒的人群中，有 178 人（0.19%）被认定为跨性别或性别多样化。与顺性别者相比，跨性别和性别多样化人群更有可能居住在伦敦（57%对 43%），年龄更小（中位数年龄 42 对 46 岁），白人种族（61%对 52%），接受精神科护理（11%对 4%），自我护理问题报告率更高（37%对 13%），以及被拒绝或延迟医疗保健（23%对 11%）。两组的抗逆转录病毒治疗使用率和病毒抑制率都很高。
与国际估计相比，居住在英格兰的跨性别和性别多样化人群中的艾滋病毒流行率相对较低。此外，在艾滋病毒护理方面没有发现不平等现象。然而，与顺性别者相比，艾滋病毒感染者中的跨性别和性别多样化人群报告的心理健康状况较差，歧视程度更高。
