Anal Cancer Risk Factors and Utilization of Anal Pap Smear Screening Among Transgender Persons Lydia A. Fein MD MPH, Adriana Wong BS, Isabella Rosa-Cunha MD, Brian Slomovitz MD, JoNell Potter MD University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology Miami, FL April 19, 2018 Disclosures • No financial relationships or conflict of interest to disclose Background Transgender An umbrella term for persons whose gender identity is different from the sex they were assigned at birth. http://www.hrc.org/resources/glossary-of-terms Background Transgender Women (TGW) Transgender Men (TGM) • Born XY • Born XX • Assigned MALE at birth • Assigned FEMALE at birth • Identify as WOMEN • Identify as MEN Background Background HPV Transgender person are known to have risk factors for anal dysplasia Receptive HIV Anal Intercourse Fein, Rosa Cunha, Slomovitz, Potter. 2018. Risk Factors for Anal Dysplasia in Transgender Women: A Retrospective Chart Review. J Low Gen Tract Dis (in press) SeveliusJ. "There's no pamphlet for the kind of sex I have": HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgendermen. J AssocNurses AIDS Care JANAC. 2009 Oct;20(5):398-410. HerbstJH, Jacobs ED, Finlayson TJ, McKleroyVS, Neumann MS, CrepazN, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008 Jan;12(1):1-17 Background • HIV • TGW have highest percentages of newly identified HIV infections • Global HIV prevalence: 20% • Receptive Anal Intercourse • 44% report unprotected, receptive anal intercourse • 42% survival sex work • Permissiveness to STIs—higher rates among transgender women • Anal HPV Infection • 67-97% transgender women have anal HPV, 82% high risk genotypes • HPV infection not always correlated with HIV infection • ASIL also found in 43% TGW • HIV-positive status was associated with ASIL detection. 1. BaralSD et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis, 13: 214-22, • Data for TGM are grossly lacking 2013. 2. HerbstJH et. al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav2008; 12(1):1-17. 3. Leon SR et. al. High prevalence of chlamydia trachomatis and Neisseria gonorrhea infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima Peru, BMJ Open 2016; 6: e008245. 4. Allan-Blitz LT, et. al. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. IntJ STD AIDS 2016; 0(0): 1-7. Background Purpose Among transgender persons: • Identify risk factors and perceived risk for anal dysplasia • Assess knowledge of anal dysplasia and associated screening • Assess receptiveness to anal pap smears Methods • Anonymous Internet-based survey designed and distributed via SurveyMonkey.com • Transgender persons recruited at health fairs, surgical clinics, and self- referral by word of mouth. • Descriptive statistical analysis was performed.