Identifying and characterizing trans women in the Swiss HIV Cohort Study as an epidemiologically distinct risk group. Clinical Infectious Disease
Nguyen et al. aimed to identify trans women in the Swiss HIV Cohort Study (SHCS) using a variety of sources. Moreover, they aimed to better understand HIV transmission events and to compare demographic, clinical, mental, and social well-being factors between trans women and MSM and cis heterosexual (HET) women in the SHCS.
The authors used a combination of criteria from pre-existing cohort data to identify trans women. Information on socioeconomic factors, clinical data, risk behaviors, and mental health was collected. They also described their phylogenetic patterns within HIV transmission networks in relation to other risk groups.
The study identified 89 trans women of a total 20 925 cohort participants. Trans women were much more likely to be Asian (30.3%) and Hispanic (15.7%) than men who have sex with men (MSM) (2.5% and 4.1%; P < .001) and cis heterosexual (HET) women (7.0% and 3.3%; P < .001). Trans women were more similar to cis HET women in some measures like educational level (postsecondary education attainment: 22.6% and 20.7% [P = .574] vs 46.5% for MSM [P < .001]), while being more similar to MSM for measures like prior syphilis diagnosis (36.0% and 44.0% [P = .170] vs 6.7% for cis HET women [P < .001]). 11.2% of trans women have been previously hospitalized for psychological reasons compared with 4.2% of MSM (P = .004) and 5.1% of cis HET women (P = .025). Analysis of transmission clusters containing trans women suggested greater affinity within the transmission networks to MSM compared with cis HET women.
In conclusion, the study show that trans women are epidemiologically distinct in the setting of the Swiss HIV epidemic. The uniquely rich and systematic data of the SHCS allowed to characterize this understudied population in unprecedented detail and depth, as well as to highlight syndemic dynamics. It is essential that further steps are taken to understand this population, as well as trans men and nonbinary trans persons, to better tailor public health interventions.