Part I of 3: Transgender people and HIV

Fort Lauderdale hosted the Fifth Annual Transgender Medical Symposium from May 14 to May 15, 2015. Jodi Reichman, Chair of the Symposium, estimated that about 275 people attended. A transman opened up the event. He spoke about the importance of humor in trans issues. He told about the times that he lost his falsie-penis in public. While serious, this symposium was not somber.

Some people conflate gender identity and sexual orientation, but they differ. Transgender people can be of any sexual orientation. Gender identity, like sexual orientation, refers to an intra-psychic sense of self. Gender expression, like sexual behavior, refers to the behavior related to that sense of self.

The term “cisgender” refers to those of us with gender identities consistent with our birth anatomy. For transmen, transwomen, and cisgender people, gender identity aligns with male/female categories. The gender identities of the gender non-conforming or genderqueer, however, do not align with those two categories. They reject that gender binary. The term “transgender” includes transmen, transwomen, and the gender non-conforming. While some transmen and transwomen surgically align their gender identity with their anatomy, not all do. Not all transman and transwomen conform to traditional gender roles.

Joanne Keatley, Executive Director of the Center of Excellence for Transgender Health, spoke on HIV infection rates and transgender people. A Lancet article reported an HIV infection rate of around 20 percent among trans people in the U.S.

A study of HIV viral load in San Francisco found a rate of HIV viral load among transgenders about 2.9 times that among non-transgenders. HIV viral load measures active HIV in the body. An undetectable viral load indicates good health. Transwomen have much higher rates of HIV infection than do transmen. African American transwomen have the highest rates.

Keatley reported that many factors contributed to high rates among transwomen, particularly employment discrimination leading to survival sex work. A second factor concerned a failure to design HIV prevention programs specifically for transwomen. She emphasized that access to female hormones would be a major incentive to stay in HIV treatment programs and clinical trials.

She reported that PrEP results have been inconclusive among transwomen. Those inconclusive results may arise more from the few transwomen in this study rather than from anything to do with PrEP. She advocated designing a PrEP study specifically for transwomen.

Keatley also suggested that differences between a surgically constructed vagina (a neo-vagina) and a biologically constructed vagina (a bio-vagina) might also contribute to these higher rates of HIV infection. A neo-vagina and a bio-vagina have different levels of elasticity, consist of different materials, and have different depths. Dr. Christian Salgado, a surgeon specializing in trans surgeries, reported that a neo-vagina averages about five inches deep, but a bio-vagina averages about seven and a half inches deep. This results in greater potential for tearing. Transwomen without trans surgery will have the same sexual options as gay and bi men, anal and oral intercourse.

Jodi Reichman described the goal of the Symposium as becoming “the main educational conference for licensed professionals, providers, and students in the South.” This Symposium also offered a great deal for non-medical providers. This story forms Part 1 of a three part series. Part II will concern issues that transgenders face, and Part III will concern trans surgeries.

Another trans event in Fort Lauderdale The Twenty-Fifth Annual Southern Comfort Conference, will occur in Fort Lauderdale, September 29 through October 3, 2015. For more information visit