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  Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 39  |  Issue : 1  |  Page : 18-22
 

A study of behavioral and disease patterns among transgenders in a tertiary care center


Department of DVL, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Date of Web Publication21-Jun-2018

Correspondence Address:
Dr. Najuk Mehta
Department of DVL, Mahatma Gandhi Medical College and Research Institute, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2589-0557.229941

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   Abstract 

Introduction: Transgenders are a group whose sexual identity, orientation, and practices differ from majority of the society. Aim: The aim of the study is to highlight the presence of infectious and noninfectious dermatological and venereal diseases among transgender population. Materials and Methods: A retrospective study was conducted on 120 transgender patients who attended DVL OPD from January 2011 to April 2015. The demographic profile, behavioral patterns, and prevalence of infectious and noninfectious dermatological and venereal diseases were studied. Results: All transgenders were male to females. Almost 46.6% (56) of transgenders belonged to age group 21-30, 25% (30) to 11-20 and 30-40, and 3.4% to >40 years. Nearly 61.3% (74) completed high school, 14.7% (18) graduation, 12% (14) primary school, 9% (10) higher secondary, and 1.3% (2) were illiterate and postgraduates each. All had multiple sex partners at certain point of time, of which 25% (31) are now committed to a single partner and 15% (19) involved in commercial sex. The safe sexual practice was followed by 68% (84). Among sexual practices, oral contributed 97.3% (117), anal 92% (110.4), finger 9% (11), thigh 6% (7), and vaginal 24% (28.8). Of 120 patients, 63.3% (76) had infectious diseases, 42.5% (51) had noninfectious diseases, and 5.9% (7) had both. Nearly 76.3% (58) had infectious dermatological diseases 76.3 (58) and 23.7% (18) had venereal infections. Noninfectious dermatological diseases accounted for 96.1% (49) and venereal diseases for 4% (2). Conclusion: There was relatively lower prevalence of infectious venereal diseases among transgender population, attributable to the good level of awareness among them.


Keywords: Behavioral patterns, dermatological infections, sexual practices, transgenders, venereal infections


How to cite this article:
Tamilselvan BP, Mehta N, Shanmugam S, Subramanian K. A study of behavioral and disease patterns among transgenders in a tertiary care center. Indian J Sex Transm Dis 2018;39:18-22

How to cite this URL:
Tamilselvan BP, Mehta N, Shanmugam S, Subramanian K. A study of behavioral and disease patterns among transgenders in a tertiary care center. Indian J Sex Transm Dis [serial online] 2018 [cited 2018 Nov 13];39:18-22. Available from: http://www.ijstd.org/text.asp?2018/39/1/18/229941



   Introduction Top


Transgender persons are biological males who dress and socially behave as females, whose identity or behavior fall outside the usual stereotype gender norms. This group is often stigmatized and may use sex for a living.[1]. Transgenders constitute an important group for the transmission of sexually transmitted infections (STIs).[2],[3]. They are usually included under males having sex with men category, throughout the world, including India. Worldwide, transgender people are marginalized and go through high levels of social exclusion and challenges. They are unable to achieve their full health potential as it is limited in to a number of settings by laws that criminalize same-sex relationships and sexual/gender diversity [4]. Our study is to highlight the prevalence of infectious and noninfectious dermatological and venereal diseases among the transgender patients who attended the transgender clinic.


   Materials and Methods Top


All the 120 transgender persons, irrespective of emasculation status and/or attire, who had attended the transgender clinic were included in the study. Key elements of the study such as (i) Demographic information comprising the (a) patient age, (b) educational status, and (c) marital status; (ii) sexual orientation and history of last sexual contact; (iii) sexual practices; (iv) chief complaint of presentation; and (v) serological results of HIV and venereal disease research laboratory were analyzed and studied in a retrospective manner from the hospital records. Percentage analysis was done to determine the demographic patterns and to study the prevalence of infectious and noninfectious dermatoses among the transgender persons.


   Results Top


All transgenders were male to females. A majority of the patients belonged to age group 21-30 years constituting 46.6% (56) of the population, followed by the age group 11-20 and 30-40 years each constituting 25% (30). The least amount was from the age group >40 years forming 3.4% of the population. The youngest patient was 16 years old and the oldest was 56 years old [Figure 1].
Figure 1: Age distribution of transgenders

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Among the 120 transgenders, 77 (64.3%) of them were educated upto high school, 18 (14.7%) had completed graduation, 12 (10.5%) had completed primary schooling, 9 (7.8%) were educated upto higher secondary, 2 (1.3%) had completed post-graduation, and 2 (1.3%) were illiterates [Table 1].
Table 1: Educational status of the transgenders

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All the 120 (100%) transgenders were passive partners with men they maintained casual sexual relationship with. They have had multiple sex partners at certain point of time, of which 25% (31) are now committed to a single partner and 15% (19) involved in commercial sex work.

Of the 120 patients, 95% (114) indulged in fellatio-oral intercourse, 93% (111) practiced anal intercourse, and 41% indulged in unprotected receptive anal intercourse, 11% practiced non penetrative form of sex, where the partners' penis was placed between their two fingers and 8% (10) nonpenetrative sex between thighs and 22% (26) of the transgenders practiced unprotected vaginal intercourse with their female partners [Table 2].
Table 2: Distribution of sexual practices

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Of 120 patients, 63.3% (76) had infectious disease, 42.5% (51) had non-infectious disease, and 5.9% (7) had both. Of 76 patients with infectious diseases, 76.3% (58) had dermatological and 23.7% (18) had venereal infections [Figure 2].
Figure 2: Prevalence of infectious dermatological and venereal diseases

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Of 58 patients with dermatological infections, fungal infections were highest accounting for 68.9% (40), 12% (7) for bacterial infections, 12% (7) for parasitic infections and least with viral infections attributing 6.9% (4). Among 18 venereal infections, 55.6% (10) patients had viral [Figure 3] and [Figure 4], 22.2% (4) fungal, 16.7% (3) parasitic, and 11.1% (2) had bacterial infections [Figure 5] and [Figure 6].
Figure 3: Condyloma acuminata 1

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Figure 4: Condyloma acuminata 2

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Figure 5: Distribution of dermatological and venereal diseases

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Figure 6: Distribution of venereal infections

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Noninfectious dermatological diseases accounted for 96.1% (49) and venereal diseases for 4% (2). Among the dermatological diseases, acne vulgaris was highest with 32.6% (16), 30.6% (15) of them had eczema, followed by 10.2% (5) transgenders with lichen planus. About 6.1% (3) of the remaining transgenders had psoriasis vulgaris, urticaria, pruritus, acanthosis nigricans, keloid, and aphthous stomatitis each [Table 3].
Table 3: Distribution of noninfectious dermatological and venereal diseases

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Of two patients with non-infectious venereal dermatoses, both had benign pearly penile papillomatosis.

All the 120 patients were negative for HIV infection.


   Discussion Top


Transgender is an international umbrella term for individuals who relate to and/or behave sexually in a manner different from their birth sex. They often express discomfort with their biological gender.[5],[6] Transgenders broadly include the following groups: (1) Transsexuals, (2) transgenderist, (3) bigenderist, (4) transvestites and (5) drag queens or kings.[7]

In India, the estimation of high risk men who have sex with men and transgender population is about 4.27 lakhs. The transgender community forms a diverse group of population. Due to varying cultural and social differences and patriarchal society, many transgenders do not expose their sexual identity and even get married. These transgenders constitute an important bridge for transmission of HIV or other STI to the population.[8],[9]

All the 120 patients in our study identified themselves as male to female. In our study, we provide data on demographic profile, behavioral patterns, and prevelance of infectious and noninfectious dermatological and venereal dermatoses among the 120 transgender patients.

One of the demographic characteristics we observed from the study was that maximum number of patients belonged to the age group 21- 30 years and the mean age of transgenders in our study was 27.4 years. Indian studies by Setia et al. Brahman et al. also observed similar findings.[10],[11] These data suggest that majority of patients from this community who presented to hospitals belonged to younger age group.

The majority of our patients had completed high School whereas only 1.3% were illiterates. Chakrapani et al. also reported similar findings where over half of their patients had completed high school.[12] Higher education and income can attribute to lesser likelihood in unprotected receptive anal intercourse.[13]

Only 15% indulged in commercial sex work which was low compared to the reports from other studies by Shinde et al., Chakrapani et al., and Khan et al., where the majority of patients were commercial sex workers which was their primary source of income [11],[13] and limits their ability to negotiate their protection terms.

A sexual practice where the partner's penis was inserted between two fingers was reported among 11% was unique to our study and has been reported in only in one other study by Shinde et al. where 64% practiced the same. All 120 patients have had multiple partners which was consistent with all other studies that have multiple partners.

Infectious dermatological diseases with a majority of fungal infections were more prevalent among the study group. Tinea cruris and tinea corporis of the dermatophytic infections were the most common dermatological infections seen. The other most common infections were scabies among the parasitic, verruca vulgaris the most common viral infection, and folliculitis among the bacterial infections.

Among the venereal infections, viral infections were more prevalent with condyloma acuminata (55.6%) being the most common disease followed by candidal balanoposthitis and perianal intertrigo (22.2%) and genital scabies (16.7%). One of the interesting findings in our study was that the highest prevalence of venereal viral infections could be significantly attributable to the sexual practice followed by them. The second most common sexual practice in the study group was anal route, and the most common viral infection noted was condyloma acuminata of the perianal region.

Two patients were diagnosed with primary syphilis and were treated for the same. Shinde et al. reported a 32% prevalence of STI in their study, with a majority of perianal warts and genital scabies similar to our study. Our study results were inconsistent with Khan et al. where there was a high prevalence of syphilis, chlamydia, and gonorrhea.[14]

Noninfectious dermatological diseases were noted in 49 patients. Acne vulgaris (32.6%) was the most common dermatoses followed by eczema (30.6%). In our study, lichen planus and psoriasis vulgaris contributed each 10.2% and 3%, respectively.


   Conclusion Top


Sex workers are among the key populations to transmit HIV and other STIs due to multiple factors, including a large number of sex partners, unsafe working conditions, and barriers to consistent condom usage. Transgenders who are involved in commercial sex act as a bridge for unnoticed transmission of STI among vulnerable population in a community.

An elaborate study on the behavioral patterns and various sexual practices among the transgenders is important to understand the contexts within which sex work occurs, the power structures surrounding it, and their social needs. Knowledge of both clinical and demographic profile of the STI population helps provide technical recommendations to actively support the development of effective intervention programs that are transgender targeted.

Training on interacting with transgender people should be made available to health-care professionals to help remove barriers and increase the level of service for the transgender population. Proper healthcare facilities for transgenders on both psychological and physical health grounds helps remove the emotional strain dealt due to stigma and promptly improve their quality of life. Many studies have shown lower prevalence of STI, HIV, lower-risk behaviors which may be attributed to higher education and income with less chances of indulging in sex work. Transgenders targeted effective intervention programs have the potential to both improve the health of individual sex workers and slow STI transmission among vulnerable populations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rusell D. Sexually transmitted Infections in Transgender persons. In: Russel D, Bradford D, Fairley C, editors. Sexual Health Medicine. 2nd edition. Sydney: IP communications; 2005. P. 951-4.  Back to cited text no. 1
    
2.
Sharma VK, Khandpur S. Epidemiology of STD's. In: Sharma VK, Bhargava R, Usman N, Sethuraman G, Kar HK, editors. Sexually Transmitted Diseases and HIV/AIDS. 2nd ed. New Delhi: Viva Books; 2003. p. 3-41.  Back to cited text no. 2
    
3.
Saravanamurthy PS, Rajendiran P, Miranda PM, Ashok G, Raghavan SS, Ansten JH. A cross sectional study of sexual practices, sexually transmitted infections and human immunodeficiency virus among male to female transgender people. Am Med J 2010;1:87-93.  Back to cited text no. 3
    
4.
Carlos F. Caceres, Antonio Gerbase, Ying-Ru Lo and Michelle Rodolph. Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender populations: Report of a technical consultation. WHO Document Production Services, Geneva, Switzerland. 2011.  Back to cited text no. 4
    
5.
Schulden JD, Song B, Barros A, Mares-DelGrasso A, Martin CW, Ramirez R. Rapid HIV testing in transgender communities by community based organizations in three cities. Public Health Rep 2008;123 Suppl 3:101-14.  Back to cited text no. 5
    
6.
Bockting WO, Simon Rosser BR, Coleman E. Transgender HIV prevention: A model education workshop. J Gay Lesbian Med Assoc 2000;4:175-83.  Back to cited text no. 6
    
7.
Gear S. Rules of engagement: Structuring sex and damage in men's prisons and beyond. Cult Health Sex 2005;7:195-208.  Back to cited text no. 7
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8.
Garg T, Chander R, Jain A, Barara M. Sexually transmitted diseases among men who have sex with men: A retrospective analysis from Suraksha clinic in a tertiary care hospital. Indian J Sex Transm Dis 2012;33:16-9.  Back to cited text no. 8
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Chakrapani V, Newman PA, Shunmugam M. Secondary HIV prevention among Kothi- identified MSM in Chennai, India. Cult Health Sexual 2008;10:313-27.  Back to cited text no. 9
    
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Setia MS, Lindan C, Jerajani HR et al. Men who have sex with men and transgenders in Mumbai, India: An emerging risk group for STIs and HIV. Indian J Dermatol Venereol Leprol. 2006;72:425-31.  Back to cited text no. 10
    
11.
Brahmam GN, Kodavalla V, Rajkumar H, Rachakulla HK, Kallam S, Myakala SP, et al. Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India. AIDS 2008;22:45-57.  Back to cited text no. 11
    
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Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India. AIDS Care 2011;23:1687-94.  Back to cited text no. 12
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Shinde S, Setia MS, Row-Kavi A, Anand V, Jerajani H. Male sex workers: Are we ignoring a risk group in Mumbai, India? Indian J Dermatol Venereol Leprol 2009;75:41-6.  Back to cited text no. 13
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Khan AA, Rehan N, Qayyum K, Khan A. Correlates and prevalence of HIV and sexually transmitted infections among Hijras (male transgenders) in Pakistan. Int J STD AIDS 2008;19:817-20  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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