Background: Despite the growing recognition of gender affirmative hormone treatment (GAHT) as an essential part of comprehensive health care for transgender women, evidence is limited on the roles of GAHT-services in HIV programming for transgender women. We examined the potential role of GAHT-services as an entry-point to facilitate uptake of HIV and other sexual health services.
Methods: Established in 2015, the Tangerine Community Health Center is the first clinic in Asia where fee-based GAHT-services are fully integrated with HIV services. Characteristics of transgender women clients and their access to GAHT-services and other health services were recorded. We compared the uptake of HIV and other sexual health services between transgender women who accessed or did not access GAHT-services.
Results: Of 972 transgender women who attended the clinic between November 2015-December 2017, median (IQR) age was 25.4 (22.5-30) years, 55% had education below bachelor''s degree, 25% were unemployed, 56% used alcohol, and 10% used amphetamine-type stimulants. GAHT-services were used by 34% of transgender women. At baseline, 91% received HIV testing, and HIV prevalence was 12%. Antiretroviral therapy initiation was successful in 80%. Transgender women who did not use GAHT-services had lower income (65% vs. 45% earned < $571/month, p< 0.001), higher HIV prevalence
(13% vs. 3%, p< 0.001), and a trend toward higher HIV incidence than those who used GAHT-services. Compared to clients not accessing GAHT-services, GAHT-service clients were more likely to re-visit the clinic (50% vs. 34%, p< 0.001), had higher rates of repeat HIV testing (32% vs. 25%, p=0.019), repeat syphilis testing (14% vs. 9%, p=0.026), PrEP uptake (10% vs. 6%, p=0.015), and use of other sexual health services, including hepatitis B testing/vaccination and sexually transmitted infection treatment (50% vs. 34%, p< 0.001).
Conclusions: Integration of GAHT-services into HIV programming in this cohort showed improvement of retention in the program and subsequent increase of sexual health service utilization, including PrEP. Transgender women not accessing GAHT-services appeared to be highly vulnerable to HIV infection. HIV program managers, policymakers, and institutional donors should consider investing in well-tailored, subsidized, and comprehensive HIV and sexual health service packages that fully integrate GAHT-services for transgender women.