Quirks & Quarks

HIV testing study of trans people in the U.K. reveals health-care gaps

Researchers have found HIV testing rates skyrocket in transgender people, an at-risk group, when they are supplied with self-testing kits — but that promising sign also points to a bigger problem in the health-care system.

Access to self-test kits triples testing rates, pointing to bigger problem in health-care, say researchers

HIV testing rates tripled for trans people who were provided with self-testing kits like this one in a U.K. study. (Anne Koerber)

A team of U.K. researchers including Dr. Charles Witzel, assistant professor at the London School of Hygiene & Tropical Medicine, found testing rates tripled among a group of about 120 trans men and women when they were given access to HIV self-testing kits. The results recently published in the journal EClinicalMedicine.

Data was gathered over a two year period in England and Wales.

About 40 per cent of those in the study were given only directions on how to access HIV testing through the conventional channels in sexual health clinics. The rest were given at least one self-test kit and instructions on how to use them; a subset of that group was provided access to kits on a repeat basis every three months.

After two years, researchers found just over a quarter of the group that wasn't given kits sought out an HIV test. Self-testing rates for those given kits, either once or on a recurring basis, were three times higher.

Dr. Charles Witzel is an assistant professor and public health researcher at the London School of Hygiene & Tropical Medicine. (Submitted by Dr. Charles Witzel)

On the surface, the increase may seem like a public health win. Trans people are considered at a higher risk of contracting HIV compared to some other populations, so a boost in testing could save lives and prevent transmission.

Talen Wright, a trans woman and researcher in the psychiatry department at University College London, helped follow-up with those in the study. Interviews revealed trans people preferred the privacy of self-testing in part because it meant they could avoid the routine discrimination they face when accessing services at most sexual health clinics, according to the research.

The discrimination took several forms, including reported encounters with staff with inadequate training on trans health issues. They said health-care professionals had misgendered them in the past, which can be traumatizing and cause dysphoria, and had interactions with clinic staff who didn't believe they were who they said they were.

"They're not taken seriously as people, their identities aren't respected and I think it just points to the need for really urgent reform," said Witzel. "What really troubled me about what came out of this is that it's not that difficult to do better."

Reform could be achieved by ensuring trans people are involved in determining how services are delivered in a way that meets their unique needs, he said.

Witzel hasn't studied this in a Canadian context, though he thinks the same undercurrents exist here and in the U.S. He feels the issues could be more pronounced across the pond.

"One of our myriad culture wars is around the place of trans people in society. Some of this is stoked by a children's author, who shall not be named, and it's a really febrile environment. It's hard to describe how difficult it is for trans people in the U.K. at the moment."

Written and produced by Bryce Hoye


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