Reisner, S.L., Murchison, G.R. Global Public Health (January 2016):1–22, e-publication ahead of print.
Assessing the risks of HIV infection and sexually transmitted infections (STIs) in female-to-male transgender persons (FTMs) is difficult because data on this population are very limited. The authors reviewed 25 peer-reviewed studies published online before August 2014 and 11 grey literature reports providing FTM-specific data on sexual risk behavior, HIV status, or STI infection. They were unable to identify any data on biomedical prevention strategies, such as microbicides or HIV pre-exposure prophylaxis in FTMs. Moreover, FTMs were typically excluded from drug efficacy trials, even those that include transgender women. There were no studies using longitudinal cohort designs to examine FTMs' sexual behavior over time, and epidemiologic studies on sexual risk among FTMs were mainly from the U.S. or Canada. The authors made several recommendations to guide future research efforts: (1) capture transgender identity in health surveillance systems to understand HIV and STI prevalence in these populations; (2) develop validated and standardized sexual risk assessments that are acceptable to transgender and non-transgender populations alike; and (3) acknowledge the range of gender identities in FTMs, considering both the potential challenges and protective effects of non-binary identity (gender identity that is neither exclusively male nor exclusively female) for sexual health.