TRANSGENDERED

& HIV / AIDS

THE ISSUE

IMPACT OF HIV / AIDS ON TG

RISK FACTORS FOR TG

LONG-TERM HORMONAL THERAPY

A WORD OF CAUTION

Health & Safety



The Issue
Since there has been very little focused research addressing the HIV / AIDS issues of the TRANSGENDERED community, we at the High Risk Project Society found it important to network on a national and international level with various TRANSGENDERED and non-TRANSGENDERED groups in order to uncover some of the facts presented within. We have also been instrumental in implementing the Vancouver BC portion of research for the report "HIV /AIDS and Transgendered Communities in Canada" by Ki Namaste. It should be emphasized that there is a lack of data which appears to be directly related to systemic confusion on the difference; between sexual orientation and identity. Therefore it is not surprising that organization addressing such issues as HIV / AIDS in the TRANSGENDERED community have been stereotyping it to a subsection of the gay community. It is also not unusual to see that the TRANSGENDERED community at large does not think of themselves at risk for HIV / AIDS since they think of themselves as outside of the gay community and there continues to be perceived stigma of HIV /AIDS being a gay disease. However it has been noted across Canada by various street front-line workers of service providing agencies that the TRANSGENDERED population has a higher rate of seroconversion than any other and yet there is little or no support for this target population.

IMPACT OF HIV / AIDS ON TRANSGENDERED
INDIVIDUALS

* there might be extra stigmatization
* there is/might be persistent feelings of being extra vulnerable as a sexual minority
* being HIV / AIDS may affect social support as you may already be marginalized as a TRANSGENDERED
* living with HIV / AIDS may affect the relationship with your partner and there may be a decrease in sexual intimacy
* many TRANSGENDERED people report that HIV / AIDS affects their living conditions and standards of living
* many reported a lack of knowledge by professionals towards TRANSGENDERED persons
* HIV / AIDS may complicate the process of obtaining hormonal treatment or sex reassignment surgery as many doctors / surgeons may be unwilling to treat seropositive TRANSGENDERED persons.

REPORTED RISK FACTORS BY TRANSGENDERED
PERSONS

* Being Sexually Active;
* performing various sex acts with multiple partners
* acting out sexually in order to get validated as a person
* many report saying no to unsafe sex practices and 15 minutes later, resorting to such practices again
* a feeling of hopelessness persists as no cure is in sight; the thought of using a condom all the time is not appealing
* myth that "it won't happen to me!"
* being infatuated and not thinking about safe sex and relapse to unsafe practices
* not informing the sex partner of one's HIV status
* sex without condom is more intimate instead of worrying and making it an ordeal
* a male to female transsexual may still have a prostate gland which may secrete pre-ejaculatory fluids which can be highly infectious during oral sex
* a vagina created by colon resection may be at an increase risk of infection due to increased absorption into the body
* if you have unprotected sex without proper lubrication, there may be tissue damage which may cause bleeding and you therefore place yourself at maximum risk if semen is infectious

Alcohol and Drugs;
* decreased inhibition therefore increase risk in unsafe practices
* sharing needles for drugs
* sharing needles for injection hormones
* picking up partners in bars to get gender identity affirmed

Prostitution;
* clients at times deliberately break condoms when they are about to ejaculate
* clients pay more money to have sex without a condom
* different rules for sex with clients and partners
* increased stigmatization of TRANSGENDERED prostitutes
* increased risk of violence will increase the risk of blood letting

Sexual conflict and confusion of the TRANSGENDERED identity complicates talking about sex since sexual activities are different when one lives in constant frustration.
Also stigma, lack of acceptance and low self-esteem limit the number of potential partners, leading to high risk behaviors.

Secrecy about gender dysphoria and being married increases the risks as many heterosexual TV and TS resort to hiring the services of prostitutes to act out their desires or live their identities.

LONG-TERM HORMONAL THERAPY & IT'S
IMPLICATIONS;

1] Estrogen, progesterone and anti-androgen use in male to female transsexuals effects many changes which may have significant implications for a person with HIV / AIDS.


Nails; increased chipping / cracking / breaking due to subclinical yeast or monomial infection candidiasis.

Muscle Mass and Habitus; long-term use of estrogen may cause a diminished muscle strength and an increased fat deposition; water retention may occur; edema; mood shift; phlebitis

Testicular volume will be reduced and the cells responsible for testosterone will decrease as well as testosterone levels. Interest in sexual activity will diminish considerably.

Eyes; changes may occur which will affect the shape of the globe and may affect the vision.

Veins; small surface veins may become prominent and unsightly.

Biochemical Changes; estrogen decreases cholesterol and the LDL faction in the bloodstream and elevates the HDL portion.

Liver; estrogen is metabolized in the liver and may elevate liver enzymes.

Prostate; may expect shrinkage of the gland.

Prolactin levels may increase which causes the breast nipple to secrete or may cause the pituitary gland to enlarge and may or may not cause hyperplasia or adenomas (tumors).

2]
Androgen hormonal therapy in the female to male transsexuals also effect many changes which may have significant implications for an HIV / AIDS individual; there is cessation of the menstrual cycle
* it affects the voice box and the voice
* there is a notable increase in muscle mass and development of muscle, therefore a balanced diet is very important
* there might be an increase in aggressiveness and it can put the individual at risk for increase violence
* hypertension may become a problem
* phlebitis may become a problem
* androgen therapy affects cholesterol levels and increases the risk of cardiac disease.

A WORD OF CAUTION;
Some of the hormonal products are much more potent than others and these
are a mild form of steroid derivative. To our knowledge at High Risk, we believe
that there has been no specific research as to the implications of hormonal therapy /
HIV / AIDS on TRANSGENDERED persons and can only report the observable effects.
However we also believe that it is not unfounded to imply that long-term use of
hormones in a person with compromised immunity may have serious health
implications. Therefore, we recommend to all persons to adhere strictly to regimens
set by your physician and to be rigorously honest with your doctor.

HEALTH & SAFETY
Health
Chain of Infection
It shall be standard policy of High Risk Project Society that universal precautions shall be used at all times when dealing with any injury, accident, food handling, seizure or procedure/duty involving potentially harmful results.

The chain of infection requires that six links be present. These are:
1. an infectious agent is present in sufficient amount to cause an infection
2. a site for the organism to multiply and grow
3. an exit site for the organism
4. a method of transport from exit site to other areas
5. an entrance site
6. a susceptible host or medium in which to grow

The principle of medical asepsis prevents the growth and spread of pathogenic micro-organisms from one individual or environment to another. It is, therefore, mandatory when dealing with the procedures listed in the first paragraph, to use the following protocols before and after the incident/duty for hand-washing:
1. Remove rings and wrist jewelry
2. Wet hands from wrist to fingernails
3. Rub bacteriostatic soap vigorously onto all areas for 15 - 30 seconds
4. Rinse from fingernails to wrist under flow of water
5. Repeat
6. Dry hands from fingers to wrist.


Puncture Injuries
Needle stick puncture injuries account for a large number of work-related accidents reported in hospitals. Most injuries happen on patient care units where the personnel are disposing of used needles, administering injections, drawing blood, recapping needles after use, or cleaning up after patient care procedures in which needles are used. Given that H.R.P. does not administer any kind of medication by injection, we will be concerned only with the risk of puncture injuries. The risk of injury will be reduced if personnel use caution when cleaning up after procedures that include the use of sharp objects. In addition to the above safety hazard, puncture wounds also pose the risk of potential infection and personnel may be at risk from improperly discarded instruments or broken glass. Razor blades pose a special risk for everyone at H.R.P., therefore, all used needles, razor blades and other discarded sharp objects and broken glass shall be placed into the prominently-labeled puncture-resistant container designated specifically for this purpose.
If you suffer a puncture injury observe the following protocols:
1. Scrub the area with a bacteriostatic soap for 3 - 4 minutes, rubbing from the centre of the injury outward
2. Clean with an antibacterial wipe
3. File an incident report
4. Have blood tests done
Hygiene of Clientele/ Members
Given that many of our members have health and hygiene problems it is important to ensure that at least minimum standards are enforced. Thus, those individuals who present as requiring baths should be actively encouraged to go and bathe when possible.


First Aid Kit
To ensure that supplies on hand are used to the fullest extent and for the original purpose, the staff shall administer first aid treatment as indicated. In the event the above is unsuitable or not possible, appropriate supplies may be given out in the quantity immediately required. When a condition exists which will be ongoing, the person/member shall be referred to the Downtown Clinic for treatment and to obtain personal first aid supplies. It may be appropriate to arrange for a home nurse to attend the clinic regularly for that same purpose. The intent is to ensure that those with ongoing conditions utilize the supplies provided by the medical community rather than our limited resources. This will also ensure that the individual's condition is monitored by medical personnel.

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HIGH RISK PROJECT SOCIETY 449EAST HASTINGS STREET, VANCOUVER B.C., V6A 1P5 Tel;(604)255-6143 - fax;(604)255-0147 - email; hrp@direct.ca

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