Transgender Vets Suffer Higher Rates of Mental and Medical Health Issues

By Eric Brus

In recent years, many research studies have identified significant health disparities -- including very high rates of HIV infection -- among transgender persons. However, there have been no large controlled studies examining health disparities among transgender persons for a range of mental and medical health conditions.

To shed additional light on transgender health disparities, a research team led by George Brown of Mountain Home Veterans Affairs Medical Center have completed what they describe as "the first study to examine a large cohort of clinically diagnosed transgender patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group."

For their study, Brown and colleagues reviewed electronic health records from the Veterans Health Administration (VHA) and identified a cohort of 5,135 transgender patients treated in VHA facilities during the period from 1996 through 2013. They compared the rates of selected mental and medical health conditions in these transgender veterans to the rates seen in a matched control group of non-transgender veterans.

The researchers found statistically significant disparities in the transgender veterans for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. Transgender veterans were also more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. The transgender veterans also had significantly higher prevalence for 16 of the 17 medical diagnoses examined. The greatest disparity was in the rate of HIV infection, which was nearly five times higher among transgender veterans than in the control group.

"This study takes an important step in identifying the nearly global nature of medical and mental health disparities in a transgender population in the largest integrated healthcare system in the United States, but it cannot provide the deeper understanding of the sources of these disparities, which are likely to include a variety of factors," the researchers noted. "Such factors are likely to include, at a minimum, a history of an unwelcoming environment for transgender veterans at many VHA facilities, lack of knowledgeable clinical staff to provide transgender healthcare, and conscious and unconscious bias from healthcare providers and administrative staff. It is critical to meaningfully and sensitively collect self-identified gender identity information to develop facility-level, regional, and national treatment programs targeted to the needs of transgender patients and to build appropriate clinical capacity within the organization to meet those identified needs."

PLWHAs Can Reduce Risk of Cancer

The growing availability of effective HIV treatment and care during the past 20 years has dramatically extended the lives of persons living with HIV/AIDS (PLWHA) and has sharply reduced the incidence of many HIV-related illnesses, including some cancers such as Kaposi's sarcoma. However, numerous studies have shown that the burden of cancer -- including non-HIV-related malignancies such as anal, liver, and lung cancers -- remains high among PLWHA. In a newly published
meta-analysis, Stanford University's Lesley Park and colleagues from several other research centers assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries.

The meta-analysis included 113 medical articles published during the period from 2011 through 2013 with information on the following modifiable cancer risk factors among PLWHA: smoking, alcohol consumption, overweight/obesity, and infection with human papillomavirus (HPV), hepatitis C virus (HCV) and hepatitis B virus (HBV). Based on their analyses of the data for each risk factor, the researchers estimated the overall, sex-specific, and HIV-transmission-group-specific prevalence. They then compared the calculated prevalence of these cancer risk factors in PLWHA with published prevalence estimates for the general population of U.S. adults.

PLWHA had substantially higher prevalence of several important cancer risk factors. Please note that in the summary below, the prevalence rate for PLWHA is listed first, followed by the rate in the general population, when available:

� Current smoking: 54 percent, versus 20-23 percent in U.S. adults;

� Cervical high-risk human papillomavirus (HPV) infection: 46 percent, versus 29 percent in U.S. females;

� Oral high-risk HPV infection: 16 percent, versus 4 percent in U.S. adults;

� Anal high-risk HPV infection in men who have sex with men: 68 percent, with no comparison estimate available for U.S. adults;

� Chronic hepatitis C virus infection: 26 percent, versus 0.9 percent in U.S. adults; and

� Hepatitis B virus infection: 5 percent, versus 0.3 percent in U.S. adults.

"Prevalence of smoking and oncogenic [cancer-causing] virus infections continues to be extraordinarily high among PLWHA, indicating a vital need for risk factor reduction efforts," the researchers concluded. Risk-reduction interventions for cancer-causing viruses include vaccinations to prevent HPV and HBV infections, as well as treatment for HBV and HCV.

They also noted that, "Research is needed to develop effective, tailored smoking cessation interventions, including for sub-populations," such as persons who inject drugs and gay, bisexual, and other men who have sex with men.

Eric Brus is the Director of Health Information at AIDS Action Committee. This report is produced by the Health Library of the AIDS Action Committee in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.