The barriers faced by trans people
Dr Kamilla Kamaruddin
The uptake of sexual health screening by trans and non-binary individuals in primary care is sadly lacking, and there are many reasons that contribute to this poor uptake.
Trans and non-binary individuals may face multiple barriers, and not come to their GP practices to request a sexual health screening. They might not be aware of local services, and may lack the education to access services. Alternatively, they may lack confidence in medical professionals, or have prior negative experiences with medical professionals.
General practice should be able to provide an inclusive and supportive environment for trans and non-binary people, where appropriate sexual health services can be offered. Medical staff at GP practices should receive training in trans awareness, so they understand the specific needs of trans people. Trans and non-binary people form a vulnerable group, experiencing a higher risk of sexual assault, and having higher percentages in voluntary and forced sex work. There’s also a higher prevalence of alcohol and drug abuse, and all of these factors contribute to a higher risk of contracting HIV and sexually transmitted infections.
General practice should be able to provide an inclusive and supportive environment
All trans and non-binary people should be offered HIV, syphilis, hepatitis B and C screening testing in general practice settings. Trans men with a cervix should be offered an RNA female self-swab, and for other trans individuals, an RNA urine test is appropriate for chlamydia and gonorrhea testing. Ask a trans woman if they’ve had surgical vaginoplasty, as they might require further swabs, and you can refer them further to a local sexual health clinic. Remember to work within your competence and seek help as necessary.
There’s a lack of data on HIV incidence and prevalence among trans people, and one of the biggest contributing factor is a lack of gender identification data. Sexual health clinics have started to introduce a two-tier gender registration, in their attempt to collect more data on HIV prevalence. Until there’s a better gender registration in primary care, the data on HIV among trans people continues to be underreported.
Trans people have a higher risk of contracting HIV infections, with HIV rates 49 times that of the cisgender population. There are many factors that contribute to a lack of HIV testing - there might be a stigma attached, people could worry that HIV treatment might interfere with their hormone therapy, and they might be more preoccupied with their gender transition and prioritise that over concerns about HIV. Post-exposure prophylaxis (PEP) and pre- exposure prophylaxis (PrEP) HIV treatment is available and should be offered, and a referral to a local sexual health clinic, as deemed appropriate.
It’s the responsibility of GP practices to offer sexual health screening to trans people, and there should be no discrimination. Working in partnership with trans people and making it more inclusive will definitely help to improve healthcare to trans people.
Dr Kamilla Kamaruddin is a GP partner in East London