To the Editor: In a Clinical Crossroads article, Dr Spack reviewed key elements of psychological, hormonal, and surgical management of transgender and transsexual individuals. We suggest that testing for human immunodeficiency virus (HIV) also should be included as an integral component of transgender care. Human immunodeficiency virus poses a significant threat to the health of transgender individuals. A meta-analysis of 29 studies estimated HIV infection rates of 11.8% to 27.7% among individuals seeking male-to-female (MTF) gender change (with nearly 73% unaware of their status at time of testing) and 0% to 3% among persons seeking female-to-male (FTM) gender change. Rates of HIV are 0.7% and 0.2% in gender-conforming males and females in the United States, respectively.
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