title: Integrated and Gender-Affirming Transgender Clinical Care and Research.
abstract: Transgender (trans) communities worldwide, particularly those on the trans feminine spectrum, are disproportionately burdened by HIV infection and at risk for HIV acquisition/transmission. Trans individuals represent an underserved, highly stigmatized, and under-resourced population not only in HIV prevention efforts but also in delivery of general primary medical and clinical care that is gender affirming. We offer a model of gender-affirmative integrated clinical care and community research to address and intervene on disparities in HIV infection for transgender people. We define trans terminology, briefly review the social epidemiology of HIV infection among trans individuals, highlight gender affirmation as a key social determinant of health, describe exemplar models of gender-affirmative clinical care in Boston MA, New York, NY, and San Francisco, CA, and offer suggested "best practices" for how to integrate clinical care and research for the field of HIV prevention. Holistic and culturally responsive HIV prevention interventions must be grounded in the lived realities the trans community faces to reduce disparities in HIV infection. HIV prevention interventions will be most effective if they use a structural approach and integrate primary concerns of transgender people (eg, gender-affirmative care and management of gender transition) alongside delivery of HIV-related services (eg, biobehavioral prevention, HIV testing, linkage to care, and treatment).
authors.affiliation: *General Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, The Fenway Institute, Fenway Health, Boston, MA; †Callen-Lorde Community Health Center, New York, NY; and ‡Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, Center of Excellence for Transgender Health, University of California San Francisco.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.forename: Asa
authors.initials: A
authors.lastname: Radix
authors.forename: Madeline B
authors.initials: MB
authors.lastname: Deutsch
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D057545:Social Stigma; D012959:Socioeconomic Factors; D063106:Transgender Persons