Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007-2016.

Objectives. To compare trends in HIV outcomes for cisgender and transgender persons living with HIV (PLWH) in New York City.Methods. We used HIV surveillance data for the analysis. We based CD4 count on the last measurement in a calendar year and defined viral suppression as the last viral load being less than or equal to 200 copies per milliliter in the calendar year.Results. The estimated number of PLWH increased from 73 415 in 2007 to 83 299 in 2016, including 606 transgender persons (0.8%) in 2007 and 1054 transgender persons (1.3%) in 2016. The proportion with CD4 count of 500 cells per cubic millimeter or more increased from 38% in 2007 to 61% in 2016 among cisgender persons versus 32% to 60% among transgender persons. The proportion with a suppressed viral load increased from 52% in 2007 to 80% in 2016 among cisgender persons versus 42% to 73% among transgender persons.Conclusions. Among PLWH in New York City, CD4 count and viral suppression improved during 2007 to 2016, with larger improvements among transgender persons, leading to narrower gaps. However, continuing efforts to improve HIV outcomes among transgender PLWH are needed to further eliminate disparities, particularly in viral suppression.

Aportes a la epidemiología del HIV en Argentina. Prevalencia e incidencia en grupos vulnerables / Contributions to HIV epidemiology in Argentina. Prevalence and incidence in vulnerable groups

Estudios epidemiológicos realizados en Argentina muestran que la epidemia del HIV es de tipo concentrada, con baja prevalencia en población general, pero con grupos de la población altamente afectados debido a diversos factores de vulnerabilidad. Dentro de los grupos más afectados por la epidemia de HIV/sida se encuentran las trans (transexuales, travestis y transgúnero), los "hombres que tienen sexo con hombres", los "usuarios de drogas" y las/los "trabajadoras/es sexulaes". Si bien el desconocimiento del número de individuos pertenecientes a estos grupos hace que no podamos conocer el impacto real que los mismos tienen en la epidemia nacional, las altas prevalencias e incidencias de HIV descriptas han puesto en escena la urgencia de un enfoque integral en estos grupos para poder intervenir eficientemente en la lucha contra la epidemia.

In the beginning of the epidemy, HIV-Aids required new professional knowledges and skills and signalled the shortcomings of the positivist medical model; the development and institutionalization of antirretroviral treatments brouhgt a new challenge, the problem of treatment adherence. We introduce the point of view of an anthropologist. In first place we analyze the clinical perspective and its intellectualist hermeneutics which focalizes on sick persons as individual locus of will, reason and self-control and tends to result in the construction of patients tipologies. In second place we present the variability and difficulties associated to trajectories of living with HIV and point out the importance of considering patients'experiences and their conditions fo everyday life in the dynamics of care.

Aportes a la epidemiología del HIV en Argentina. Prevalencia e incidencia en grupos vulnerables / Contributions to HIV epidemiology in Argentina. Prevalence and incidence in vulnerable groups

Estudios epidemiológicos realizados en Argentina muestran que la epidemia del HIV es de tipo concentrada, con baja prevalencia en población general, pero con grupos de la población altamente afectados debido a diversos factores de vulnerabilidad. Dentro de los grupos más afectados por la epidemia de HIV/sida se encuentran las trans (transexuales, travestis y transgúnero), los "hombres que tienen sexo con hombres", los "usuarios de drogas" y las/los "trabajadoras/es sexulaes". Si bien el desconocimiento del número de individuos pertenecientes a estos grupos hace que no podamos conocer el impacto real que los mismos tienen en la epidemia nacional, las altas prevalencias e incidencias de HIV descriptas han puesto en escena la urgencia de un enfoque integral en estos grupos para poder intervenir eficientemente en la lucha contra la epidemia.(AU)

In the beginning of the epidemy, HIV-Aids required new professional knowledges and skills and signalled the shortcomings of the positivist medical model; the development and institutionalization of antirretroviral treatments brouhgt a new challenge, the problem of treatment adherence. We introduce the point of view of an anthropologist. In first place we analyze the clinical perspective and its intellectualist hermeneutics which focalizes on sick persons as individual locus of will, reason and self-control and tends to result in the construction of patients tipologies. In second place we present the variability and difficulties associated to trajectories of living with HIV and point out the importance of considering patientsexperiences and their conditions fo everyday life in the dynamics of care.(AU)

[Overview of the biological etiology of transsexualism]. / A transzszexualizmus biológiai kóroktanának áttekintése.

Gender identity disorder, or transsexualism as it is more commonly known, is a highly complex clinical entity. The general belief among behavioural scientists and physicians is that transsexualism is an identifiable and incapacitating disease which can be diagnosed and successfully treated by reassignment surgery. Although the exact etiology of gender identity disorder is unknown, several environmental, genetic and anatomical theories have been described. The reviewers draw attention to the possible genetic, hormonal, immunological and anatomical causes. An attempt is made to point out the future trends in research, highlighting their progressive features.

Birth order and ratio of brothers to sisters in transsexuals.

BACKGROUND: As previous studies with homosexual males have revealed a later birth order, more older brothers and more brothers than sisters, this research was extended to a large series of transsexual males and females, some of whom are homosexual. METHODS: The male sample comprised 442 male-to-female transsexuals, subdivided by sexual partner preference: 106 homosexual, 135 heterosexual, 155 bisexual and 46 asexual. One hundred female-to-male transsexuals were also studied: 75 homosexual, 16 bisexual, seven heterosexual and five asexual. Birth order was computed by both Slater's Index and Berglin's Index. RESULTS: Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40 %. CONCLUSIONS: Hypotheses explaining the extension of prior findings to this large sample of transsexual males include a progressive maternal immunization to the male foetus either through the H-Y antigen or protein-bound testosterone or alterations in foetal androgen levels in successive pregnancies, all modifying male psychosexual development. Data on the sexual orientation of younger brothers of homosexual male transsexuals in this study are not consistent with the progressive immunization hypothesis.

Sexual behaviour and prevalence of HIV antibodies in transsexuals.

OBJECTIVE: To present data on the social characteristics, sexual behaviour and prevalence of HIV antibodies in 277 transsexuals. MATERIAL AND METHODS: One hundred fifty-four male and 123 female transsexuals requesting surgical gender reassignment at the National University Hospital, Singapore were interviewed using a standard questionnaire. Blood samples were also taken at booking and prior to surgery and tested for HIV antibodies using a commercial enzyme immunoassay. RESULTS: The mean ages of the male and female transsexuals were 26.3 and 28.3 years respectively. The majority of the transsexuals were Singaporean Chinese and had at least a secondary school education. None of the female and 14 (9%) of the male transsexuals were engaged in prostitution. Significantly more female (48%) than male (10.4%) transsexuals were sexually inactive. The sexual behaviour and practices of the transsexuals are also discussed. CONCLUSIONS: Significantly more male transsexuals compared to the female transsexuals, were sexually active, had earlier sexual contact, engaged more often in anal intercourse, and had 7 or more sexual partners. However, none of our transsexuals were positive for HIV antibodies.

Effect of sexual practices on T cell subsets and delayed hypersensitivity in transsexuals and female sex workers.

To determine whether ano-receptive unprotected sexual intercourse (SI) practised by transsexuals produces immunological abnormalities we compared delayed hypersensitivity skin tests (DTH) and T cell helper (CD4) and suppressor (CD8) subsets in 57 transsexuals and 69 female sex worker controls. The populations were matched for age, duration of prostitution, number of clients and previous use of antibiotics. Heterosexual males and females and transsexuals who practised protected SI, were also included as controls. All were HIV negative. There were significantly increased absolute CD4 and CD8 counts and decreased DTH and CD4/CD8 ratios in those who practised unprotected ano-receptive SI. These changes were unlikely to be due to any of the microbial agents tested. We conclude that ano-receptive sexual intercourse results in increased immunological abnormalities in these sex workers possibly as a result of rectal exposure to seminal alloantigens. These abnormalities could play an important role as co-factors in disease transmission.

Effect of ano-receptive homosexual practice on T lymphocytes and delayed hypersensitivity in transsexuals.

To determine whether ano-receptive sexual intercourse adversely affects a person's cellular immunity, we compared several immunological parameters among 100 transsexual male prostitutes and 40 heterosexual male controls, and also among different durations of prostitution. The mean ratios of CD-4 (helper/inducer) lymphocytes to CD-8 (suppressor/cytotoxic) lymphocytes and the delayed-type cutaneous hypersensitivity (DTH) scores were significantly lower in transsexuals than they were in heterosexual controls; these parameters also showed a decreasing trend with increasing duration of prostitution. Transsexuals have a significantly higher CD-8 lymphocyte count than have heterosexuals. No significant differences between transsexuals and heterosexuals were found for lymphocyte counts, pan T cells, and CD-4 cell counts. We postulate that in these subjects cellular immunity is progressively reduced, probably through repeated and prolonged antigenic challenge via receptive anal intercourse. The impairment in cellular immunity is associated with the duration of prostitution, independent of the man's age.

On the expression of H-Y antigen in transsexuals.

Histocompatibility-Y (H-Y) antigen, the presumptive inducer of the mammalian testis, is present in the cells of normal males and not in the cells of normal females. Recent reports have implied that patients with transsexualism exhibit H-Y antigen phenotypes at variance with those of normal males and females and, thus, that H-Y serology might provide a tool for the diagnosis and study of the transsexual condition. We therefore evaluated blood and testicular cells from 21 male-to-female transsexuals using conventional and monoclonal H-Y antibodies. We found no evidence of abnormal H-Y phenotype. Five of the patients were interviewed postoperatively by two examiners and rated for the diagnosis of transsexualism. Three of the five were rated primary transsexual by one or both examiners, and two were rated secondary transsexual.

H-Y antigen expression in different tissues from transsexuals.

H-Y-antigen expression was analyzed in patients with transsexuality. Peripheral blood lymphocytes and various tissues were examined using the cytotoxicity assay of Goldberg et al. (1971). Peripheral blood lymphocytes from healthy male and female subjects were used as controls as well as tissues from non-transsexual individuals and from male and female C57B1/6J mice. In three female-to-male transsexuals the peripheral blood lymphocytes were H-Y antigen positive. In these patients also their ovaries, uterus, and mammae were found to be H-Y antigen positive. Three male-to-female transsexuals were examined. The peripheral blood lymphocytes in two of these patients were found to be H-Y antigen negative. Their testes were also H-Y antigen negative, as well as the epididymus, the corpus cavernosum penis, and the cremaster muscle which was analyzed in one of them. One male-to-female transsexual had peripheral blood lymphocytes which were H-Y antigen positive; this patient had testis and corpus cavernosum penis which were also H-Y-antigen positive.

[Transexuality and X-Y antigen (author's transl)]. / Transsexualität und H-Y Antigen.

Eleven transexuals with transexuality from man to woman and a karotype 46 X-Y and 11 transexuals with transexuality from woman to man and the karotype 46 X-X were investigated for H-Y antigen. Eight of the 46 X-Y transexuals were H-Y antigen negative, one intermediately slightly positive and two H-Y antigen positive. Of the 46 X-X transexuals 9 were H-Y antigen positive, one was intermediately slightly positive and one was H-Y antigen negative. Two groups of transexuals can be distinguished. Genuine transexuals and secondary transexuals with a transvestite past who have suffered a sexual identity crisis due to the environment. The H-Y antigen is an expression of a complex of the genes which is responsible for virilization and is likely located in the Y chromosone. The gene responsible for the H-Y antigen expression is not identical with the inductor for testicular development. An explanation for the disordance of the H-Y antigen findings in transexuals is translocation or gene exchange from a Y-chromosome to an X-chromosome during meisis of the spermatogonia. In this way a morphological substrate for transexuality has been detected. H-Y antigen negative 46 X-Y males and H-Y antigen positive 46 X-X females can now be diagnosed as genuine morphological transexuals.

H-Y antigen in transsexuality, and how to explain testis differentiation in H-Y antigen-negative males and ovary differentiation in H-Y antigen-positive females.

H-Y antigen was determined in eight transsexual patients. Two of the four male-to-female transsexual patients typed as H-Y antigen-negative, while the other two typed as expected from their phenotypic and gonadal sex, namely H-Y antigen-positive. Of the four female-to-male transsexual patients, three typed as H-Y antigen-positive and one was H-Y antigen-negative, as expected. The presence of normal testes in H-Y antigen-negative males is assumed to result from a mutation of nucleotide sequences of the H-Y structural gene for antigenic determinants. Thus, an H-Y is produced with normal receptor-binding activity which can sustain the testis determination of the bipotent gonadal anlage. In the case of H-Y antigen-positive females with normal ovaries a deletion of the autosomally located H-Y structural gene is assumed. This deletion should affect sequences for repressor-binding (as was suggested for H-Y antigen-positive XX-males) and for receptor-binding activity of the H-Y antigen molecule. The resulting H-Y antigen is unable to bind to the gonadal receptor of the bipotent gonadal anlage. Thus an ovary is determined. The relevance of H-Y antigen for the aetiology of transsexualism is discussed.

Modulatory effects of oestrogen on immunologic responsiveness. I. Inhibition of DNA synthesis in peripheral blood lymphocytes from patients with Peyronie's disease, prostatic cancer and transsexuals and a commentary.

A reduction in the phytohaemagglutinin-induced transformation of peripheral blood lymphocytes from patients with Peyronie's disease and prostate cancer and transsexuals cultured in autologous and homologous serum following the receipt of oestrogen therapy has been observed. Reduction of lymphocyte transformation in patients with prostatic cancer and without malignancy receiving oestrogen, i.e., Peyronie's disease and transsexuals, suggests that this reduction is related to the mode of therapy rather than to malignancy or a particular pathologic state. No direct evidence exists that the observed in vitro aberrations of lymphocytic responsiveness are reflective of host compromise, but these observations are of potential relevance in terms of their implications in the therapeutic management of patients with prostatic cancer and other hormonally-dependent tumours, e.g., of the breast, as well as responsive diseases, through their effect on cellular immunocompetence and suitability of hormonally treated patients as prospective candidates for adjuvant immunotherapy. The possible relevance of the present observations to the suggested association between uterine cancer and prolonged administration of diethylstilboesterol, as well as that between development of vaginal tumours in offspring and maternal ingestion during pregnancy, also remains of potential concern, pending further investigation.