What is transgender?

People who feel their assigned sex at birth differs from their gender identity are generally referred to as “transgender”. Such persons may want to adapt physically, socially and legally to their true gender identity but not all may choose to do so or have the opportunity to do so in especially in more conservative countries. A person assigned as male at birth but has a female gender identity is called a “transgender woman” or a “trans woman”. A person assigned as female at birth but has a male gender identity is called a “transgender man” or a “trans man”.

Is being transgender the result of a mental illness?

No. In the latest World Health Organisation (WHO) classification of illnesses, called the International Classification of Diseases – ICD11, being transgender is not classified as a mental illness.

What is transitioning?

Transitioning is a comprehensive process during which a person moves from the assigned sex at birth towards the gender that is in line with their true self. It encompasses various medical processes by which the body of a transgender person comes to be more in line with their true gender identity. This may involve the use of hormone therapy and gender affirming surgery.

It should include and start with proper medically backed counselling and other psychotherapeutic approaches to prepare and guide the person undergoing gender transitioning for the changes in psyche and in the social environment that they will need to come to terms with.

Do all transgender people choose to transition?

Not all transgender people choose to transition; many choose to live life as their gender identity without undergoing medical procedures for transitioning.

Why are transgender people often at increased risk for HIV?

Transgender women are often at increased risk for HIV because of their involvement in unprotected anal sex with multiple partners, combined with their limited access to HIV services due to their often-marginalised position in society. Health care professionals may not know how to deal with transgender people; they may stigmatise or discriminate against them or even refuse them services. Many transgender people need to get by in life by selling sex. This is because other forms of employment (or access to education) are often blocked to them, due to societal stigma and discrimination as well as rejection by their families. This leads them to have greater exposure to HIV risk than many other people.

In order to reduce the risk of HIV, holistic interventions are needed that include measures to reduce stigma and discrimination, so that transgender people have equal education and employment opportunities.

Can ARV medications and hormones used for changing sex/gender be taken together?

Unfortunately, little is known about this. And this is a real concern. An international survey called ‘Positively Trans’ found that many trans women prioritise hormone therapy for gender confirmation/reassignment over HIV treatment, often expressing concern about how their hormones might interact with antiretroviral drugs. Such interactions could potentially reduce the effectiveness or increase the side-effects of antiretrovirals, hormones or both. Interactions between antiretrovirals and hormones for contraception have been tested, but not the different doses used for gender-related hormone therapy.

Antiretroviral treatment (ART) recommendations for transgender women using feminizing hormones are complicated by lack of data. Little data also exist on HIV among transgender men, likely due to much lower HIV prevalence. However, evidence for HIV risk among transgender men who have sex with men is growing.