title: Improving HIV Surveillance Among Transgender Populations in Tennessee.
abstract: HIV prevalence and outcome disparities among sexual and gender minorities are profound in the United States. Tennessee HIV surveillance practices have not been uniform for transgender status, although data collection capabilities exist. We, therefore, describe current reporting of data on transgender individuals in Tennessee to identify targets for improvement.
  
  
  
  Data for all HIV-diagnosed individuals living in Tennessee as of December 31, 2013, were extracted from the Enhanced HIV/AIDS Reporting System (eHARS). The birth_sex ("Male" or "Female") and current_gender ("Male," "Female," "Male-to-Female," "Female-to-Male," or "Additional Gender Identity") variables were examined, and proportion missing current_gender data by region was ascertained. Transgender individuals were defined as having different birth_sex and current_gender values. To ensure the protection of health information, data were cleaned, deidentified, and aggregated using Statistical Analysis Software (SAS) Version 9.3 (SAS Institute, Inc., Cary, NC).
  
  
  
  Among 16,063 HIV-diagnosed individuals in Tennessee, 27 were transgender: 52% (n = 14) with "Male-to-Female," 26% (n = 7) with "Female," and 22% (n = 6) with "Male" as their current_gender values. Proportions missing current_gender differed significantly by region across Tennessee (global, P < 0.01).
  
  
  
  While HIV-positive transgender individuals should be recognized as integral members of the LGBT community, they should also be acknowledged as a separate subgroup when appropriate. Collecting information about current self-identified gender identity should no longer be optional in Tennessee HIV surveillance. Although making efforts to collect both birth_sex and current_gender mandatory with each interview will improve surveillance, it is critical to train all staff properly on the correct way to inquire about gender identity in a culturally sensitive manner. Revamping data collection methods will not only improve inconsistent methods currently in place but will also allow staff to become more competent in asking the relevant questions and serving transgender individuals.
authors.affiliation: 1 HIV/STD/Viral Hepatitis Section , Tennessee Department of Health, Nashville, Tennessee.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Sizemore
authors.affiliation: 2 Department of Medicine, Division of Infectious Diseases and Division of Epidemiology, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.affiliation: 1 HIV/STD/Viral Hepatitis Section , Tennessee Department of Health, Nashville, Tennessee.
authors.forename: Shanell L
authors.initials: SL
authors.lastname: McGoy
mesh_terms: D062665:Epidemiological Monitoring; D005260:Female; D062306:Geography, Medical; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D058996:Quality Improvement; D013714:Tennessee / Q000453:epidemiology; D063106:Transgender Persons / Q000706:statistics & numerical data; D014189:Transsexualism / Q000150:complications / Q000453:epidemiology
keywords: HIV; LGBT health; sexual and gender minority; sexual health; transgender