title: HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.
abstract: OBJECTIVE
  This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV.
  
  
  METHODS
  We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV.
  
  
  RESULTS
  HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide.
  
  
  CONCLUSIONS
  High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
authors.affiliation: Epidemiology and Evaluation Section, San Francisco Department of Public Health, 25 Van Ness, #500, San Francisco, CA 94102, USA. kristen_clements@dph.sf.ca.us
authors.forename: K
authors.initials: K
authors.lastname: Clements-Nolle
authors.forename: R
authors.initials: R
authors.lastname: Marx
authors.forename: R
authors.initials: R
authors.lastname: Guzman
authors.forename: M
authors.initials: M
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012494:Sampling Studies; D012495:San Francisco / Q000453:epidemiology; D012725:Sexual Behavior; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014189:Transsexualism / Q000150:complications / Q000523:psychology*