title: Transgender people attending a Sydney sexual health service over a 16-year period.
abstract: BACKGROUND
  Previous studies have concluded that transgender people are a marginalised and stigmatised group, with high rates of sexually transmissible infections (STI), sex work, injecting drug use and multiple sexual partners. To our knowledge, this is the first study in Australia to focus on the sexual behaviour and sexual health needs of transgender people attending an urban sexual health clinic.
  
  
  METHODS
  A retrospective case note review was undertaken of the transgender attendees of the Sydney Sexual Health Centre between 1990 and 2006. Demographics, gender characteristics, risk behaviours, sexual health morbidity, psychosocial information and other significant features of the transgender population were assessed.
  
  
  RESULTS
  Forty clients were identified as transgender, of whom 36 (90%) were male-to-female and four (10%) were female-to-male. Seventeen (43%) had a history of sex work, 16 (40%) had injected drugs, 14 (35%) had had unprotected anal or vaginal sex in the past 3 months. Twenty (50%) clients had histories of a STI, including three (7.5%) that were HIV positive, and two were co-infected with hepatitis C. Genital warts and chlamydia were the most common diagnoses made during the study period. Physical examination was inadequately documented in 53% of first visits. Psychosocial morbidity was common.
  
  
  CONCLUSIONS
  Transgender clients presented infrequently at this clinic. Although half reported few risks, the other half reported multiple risk behaviours and had most STI. These findings suggest that there needs to be improved sexual health service for transgender clients at our clinic.
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, GPO Box 1614, Sydney, NSW 2001, Australia. vhounsfi@nsccahs.health.nsw.gov.au
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Hounsfield
authors.forename: Eleanor
authors.initials: E
authors.lastname: Freedman
authors.forename: Anna
authors.initials: A
authors.lastname: McNulty
authors.forename: Christopher
authors.initials: C
authors.lastname: Bourne
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014190:Transvestism / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data*