Los Angeles County Transgender Population Estimates 2012

Los Angeles County Department of Public Health Division of HIV and STD Programs

Los Angeles County Department of Public Health

JonathanE.Fielding,MD,MPH,MBA DirectorofPublicHealthandHealthOcer

CynthiaA.Harding,MPH ChiefDeputyDirector

Division of HIV and STD Programs

MarioJ.Prez,MPH Director

DouglasFrye,MD,MPH Director,HIVEpidemiologyProgram

Authors:

TristaBingham,PhD,MPH JuliCarlosHenderson,MPH

Community Contributors:
MichelleEneld,AIDSProjectLosAngeles;SusanForrest,BehavioralHealthServices,Inc.;JoanneKeatley,Centerof ExcellenceforTransgenderHealth;MiguelMar nez,ChildrensHospitalLosAngeles;Rev.MeganMore,Metropolitan CommunityChurchintheValley;JayeJohnson,NuManTransgenderSupportNetwork;SabelSamoneLoreca, CommunityMember

Health Department Contributors:

JohnCopeland;DouglasFrye;MichaelGreen;VirginiaHu;EmmanuelMendoza;HeatherNorthover;RangellOruga; HarlanRotbla ;LaTonyaTaylor;JuhuaWu;PaulinaZamudio

Contact Information:
Forques onsregardingthesees mates,pleasecontactTristaBinghamattheDivisionofHIVandSTDProgramsat 2133518175ortbingham@ph.lacounty.govorJuliCarlosHendersonat2133518173orjcarlos@ph.lacounty.gov.

Suggested Citation:
DivisionofHIVandSTDPrograms,LosAngelesCountyDepartmentofPublicHealth,LosAngelesCountyTransgender Popula onEs mates2012.
2

Background
In2007,theHIVEpidemiologyProgram(HEP),nowpartoftheDivisionofHIVandSTDPrograms(DHSP),es mated thenumberoftransgenderwomeninLosAngelesCounty(LAC)tobe4,400withanes matedHIVprevalenceof 21%*.Thises matewasincludedinthe20092013HIVPreven onPlanforLosAngelesCountyandwasmetwith muchconcernfromthecommunitywhofeltthatthenumberoftransgenderpersonswasinfactmuchhigher.Inthe previousHIVPreven onPlan(20042008),ithadbeenes matedthattherewere10,000transgenderpersonslivingin LACandthusthecommunitywasconcernedthattherevisedes materepresentedasignicantreduc on.Twoerrors inthepreviousreportareimportanttonote.First,the20092013es matewasmislabeledandreadTransgenders insteadofTransgenderWomen.Second,thees mateusedin20042008wasanes matetakenfromastatewide Californiaconsensusmee ng,whichhadbeenincorrectlycitedasaLACes materatherthanastatewidees mate. Giventheconcernfromthecommunityoverthesepastes mates,DHSPHEPengagedinaprocessthatinvolvedkey stakeholdersinthedevelopmentofanupdatedtransgenderpopula ones mate.DHSPHEPconductedaliterature reviewtoiden fynewmethodologiesandpublishedes mates.DHSPHEPthenconductedaseriesofconferencecalls withkeystakeholderstogatherfeedbackregardingthreekeyunknowns:HIVprevalenceamongtransgender individuals,thesizeofthetransgenderpopula oninLAC,andthera ooftransgenderwomentotransgendermen. Valuableinforma onwasgatheredduringthecallsandstakeholderfeedbackwasincorporatedintothedevelopment ofthenewes matespresentedinthisreport. Inordertoes matethenumberoftransgenderindividualsinLosAngelesCountyandtheHIVprevalenceforthis popula on,wedeterminedwewouldneedthefollowing:1)overallsizeofthepopula oninLACbetweentheagesof 15and64years;2)thepercentageofthepopula ones matedtobetransgender;and3)thera ooftransgender womentotransgendermen.
*Es matedthat21outof100transgenderindividualscouldbeHIVposi ve.

1. 2011 Population Estimates for Los Angeles County

Usingpopula ones matesfromtheCaliforniaDepartmentofFinance1,wedeterminedtherewereanes mated 7,213,883individualsbetweentheagesof15and64yearslivinginLACin2011.

2. Estimated Size of the Transgender Population

Inreviewingtheliterature,weiden edfourar cles/reportsthates matedthesizeofthetransgenderpopula onto bebetween0.1%and0.5%oftheoverallpopula on.
Massachuse sBRFS(2007&2009)2 0.5%ofsubjectsages1864yearswereTransgender

Reedetal.UnitedKingdom20093 0.1%ofadultsareTransgender(i.e.,transi onedinsomeway)

CaliforniaLGBTTobaccoUseSurvey(200304)4 0.1%ofadultsinCAareTransgender

2011WilliamsIns tutereport(GaryGates)5 0.3%areTransgenderaverageofpreviouses mates 3

A erconsiderablefeedback,wedecidedthat0.2%wouldbeusedtoes matethepopula onsizewitharangeof 0.1%to0.3%.Wealsoconcludedthatweneededtospecicallydenewhatwemeantbytransgenderwhen determiningthesees mates.Somestakeholderspreferredamoreinclusivedeni on,whileotherspreferredamore conserva vedeni on.Thefollowingdeni onsandtheiraccompanyingpopula onpropor onsarebeingused: 0.1%Mustiden fyasatransgendermanorwoman 0.2%Mustiden fyasatransgendermanorwoman,oriden fywithagenderdierentfromgenderatbirth 0.3%Broadiden ca onwithawidevarietyofcrossgenderbehaviorsandiden

es

Giventhepopula ones mateof7,213,883individualsbetweentheagesof15and64yearslivinginLAC,weapplied thepercentagesabovetodeterminetherangeandmidpointes matesofourtransgenderpopula on. 7,213,883*0.1%=7,214 7,213,883*0.2%=14,428 7,213,883*0.3%=21,642 Therefore,wedeterminethereisanes mated14,428transgenderpersonslivinginLACwitharangeof7,214to 21,642.

3. Estimated Ratio of Transgender Women to Transgender Men

Unfortunately,therearealmostnodataavailabletodeterminethera ooftransgenderwomentotransgendermen. Somereportsdescribethera ooftransgenderwomentomenbutusemedicaldataonsexualreassignmentwhichis toostrictacriteria.6TheCaliforniaLGBTTobaccoUseSurvey4reported62%percentoftransgenderindividualswere bornmaleand31%werebornfemalebuttherearelimita onstothesedata.Forexample,thefollowupques onon transgenderiden tywasnotaskedonceapar cipantreportedtheywerealesbianorbisexualwoman,oragayor bisexualman.Hence,withfeedbackfromourstakeholders,wedeterminedthata1:1ra owouldbeusedforthese es mates.Therefore,wees matethereare7,214transgenderwomento7,214transgendermeninLAC.

Estimated HIV Prevalence

InordertodetermineHIVprevalence,wereviewedthenumberoflivingHIV/AIDScasesamongtransgender individualsinLAC.AccordingtoHIV/AIDSsurveillancedatacollectedbyDHSPHEP,asofDecember2011,446living HIV/AIDScasesareamongtransgenderindividualsinLAC.Ofthose,430(96%)areamongtransgenderwomen.To accountforpersonswhodonotknowtheyareinfected,wees matethat21%7areunawareoftheirinfec on.Thus, wees matethat79%areawareoftheirinfec on. 430/0.79=544MTFHIV/AIDScases 16/0.79=20FTMHIV/AIDScases

Wealsoneededtoaccountformisclassica onoftransgenderstatusamongreportedcases.In2002,theStateHIV/ AIDScasereportformaddedtransgenderasagenderop on.Thus,anycasesreportedpriorto2002maynotbe representedastransgenderinoursurveillancedata.Theremayalsobeunderrepor ng(i.e.,misclassica onof gender)byproviders.Inordertoaccountforunderrepor ngoftransgendergender,wees matedthatwemayhave 4 misclassiedapproximatelyhalfofallcases.

544*2=1,088MTFHIV/AIDScases 20*2=40FTMHIV/AIDScases Givenoures mateofapproximately1,088livingHIV/AIDScasesamongtransgenderwomenandoures mateof approximately7,214transgenderwomenlivinginLAC,thees matedHIVprevalencefortransgenderwomenis 15.1%. 1,088/7,214=0.1508,or15.1% Fortransgendermen,wees mateapproximately40livingHIV/AIDScasesandapproximately7,214transgendermen livinginLAC,thereforeoures matedHIVprevalencefortransgendermenis0.6%. 40/7,214=0.0055,or0.6% Giventhatstudies813haveshownhigherHIVprevalenceamongtransgenderwomenofcolor,wedeterminedthatit wouldbecri caltoes mateHIVprevalencebyrace/ethnicity.

Estimated HIV Prevalence by Race/Ethnicity

Usingtheracial/ethnicdistribu onfromtheU.S.CensusStateandCountyQuickFacts14,weappliedthesepercentages tooures mateof7,214transgenderwomen.NotethatthepercentageforWhitetransgenderwomenwasreducedby 1.1%toadjustfortheCensusdatathatwerenotmutuallyexclusive.

Table 1: Esmated Populaon Size by Race/Ethnicity

Race/Ethnicity Black La na White Asian/PacicIslander Na veAmerican Total

Racial/Ethnic Distribuon 9.3% 48.1% 26.5% 14.6% 1.5% 100.0%

Esmated Total # of MTF* 7,214 7,214 7,214 7,214 7,214 7,214

Esmated # of MTF* by Race/Ethnicity 671 3,470 1,912 1,053 108 7,214

*MTF=TransgenderMaletoFemale

Usingtheracial/ethnicdistribu onofourHIVsurveillancedata,weappliedthesepercentagestoournewes mateof 1,088HIV/AIDScases.

Table 2: Esmated Number of HIV/AIDS Cases by Race/Ethnicity

Racial/Ethnic Distribuon of HIV/ 29.8% 54.7% 8.1% 3.6% 2.8% 1.1% 100.0% Esmated Total # of MTF* HIV/AIDS 1,088 1,088 1,088 1,088 1,088 1,088 1,088 Esmated # of MTF* HIV/AIDS cases by 324 595 88 39 30 12

Race/Ethnicity Black La na White Asian/PacicIslander Na veAmerican** Other Total

1,088

*MTF=TransgenderMaletoFemale **Toaccountformisclassica onofNa veHIV/AIDScases,wedoubledthepercentageofNa vecasesfrom1.4%to2.8%which increasedoures matefrom15to30.Webasedthismodica onondatacollectedfromTheAmericanIndian/AlaskanNa ve Valida onProject.15

Usingtheaboveracial/ethnicdistribu ons,wedeterminedthefollowingHIVprevalencees matesbyrace/ethnicity.

Table 3: Esmated HIV Prevalence by Race/Ethnicity

Esmated # HIV Cases 324 595 88 39 29 1,088 Esmated Populaon Size 671 3,470 1,912 1,053 108 7,214 Esmated HIV prevalence 48.3% 17.1% 4.6% 3.7% 26.9% 15.1%

Race/Ethnicity Black La na White Asian/PacicIslander Na veAmerican Total

*MTF=TransgenderMaletoFemale

Summary
GiventhattheU.S.Censushasneverincludedtransgenderasagendercategory,ithasbeendiculttodeterminethe actualpopula onsizeofthetransgendercommunity.Thisdocumentsummarizeshowweusedadeliberate communityfeedbackprocessandexis ngpublichealthdatatoes matethesizeofthetransgenderpopula oninLos AngelesCountyin2012.Oncewehades matedthepopula onsize,wewerealsoabletoes matetheHIV prevalence(i.e.,thepropor onofthosewithHIVdisease)fortransgenderindividualsinourCounty. Throughthiswork,wees matethatthereare14,428transgenderindividualslivinginLosAngelesCountywitha rangeof7,214to21,642.Basedoncommunityinput,wealsoconcludedthatthereisaonetoonera o(1:1)of transgenderwomen(7,214)totransgendermen(7,214).Toes mateHIVprevalence,wecompiledthreepiecesof informa on:thenumberofHIV/AIDScasesreportedamongtransgenderindividuals;thepropor onofallHIV posi vetransgenderindividualswhomaybeunawareoftheirinfec onstatus;andthenumberoftransgender individualsintheHIV/AIDScaseregistrywhomaybemisclassiedasamanorwoman.Overall,HIVprevalencefor transgenderwomen(i.e.,maletofemaletransgender)wases matedtobe15.1%and0.6%fortransgendermen(i.e., femaletomaletransgender).BecausetheliteraturesuggeststhatthereisahigherHIVprevalenceamong transgenderwomenofcolor,wecalculatedHIVprevalencees matesfortransgenderwomenstra edbyrace/ ethnicity.Basedonthesecalcula ons,weobservedthehighestHIVprevalenceforAfricanAmerican/Black transgenderwomen(48.3%),followedbyNa veAmericans(26.9%),La nas(17.1%),Whites(4.6%)andAsian/Pacic Islanders(3.7%). Giventhelackoftransgenderdataavailableincoun eslikeours,thees matespresentedherehaveseveral limita ons.First,withouttheavailabilityofU.S.Censusdataweareunabletodeterminetheactualsizeofthe transgenderpopula on.Wethereforesearchedforpopula onbasedstudiestollthisgap.Unfortunately,few popula onbasedstudiesincludetransgenderasagendercategoryoraskthetwopartques ontodeterminegender classica onasrecommendedbytheCenterofExcellence.16Wethereforewerelimitedtolessthanahandfulof studies/reportsthatincludedes matesofthesizeofthetransgenderpopula oninotherjurisdic ons.Onereport wasfromoutsidetheU.S.andtwowerepopula onbasedstudiesinCaliforniaandMassachuse s.2,4Second,wehad greatdicultyloca ngresearchdataonthera ooftransgenderwomentotransgendermenintheliterature.What wedidndwasfocusedonsexualreassignmentsurgery(SRS)sta s cs,whicharelimitedforourpurposes,sincea minorityoftransgenderindividualspursueSRS.6Basedonthefeedbackfromourcommunitystakeholders,wemade theassump onthatthera ooftransgenderwomentotransgendermenis1:1.Third,localHIV/AIDScasereport formsdidnotaddtransgenderasagenderop onun l2002.Therefore,wehadtoes mateapproximatelyhowmany HIV/AIDScasesweremisclassiedbefore2002inaddi ontothenumberthatcon nuetobemisclassieddueto healthproviderrepor ngerrorssincethen. Whiletherearelimita onstothees matespresentedinthisreport,weneedtoberesourcefulandusethedatathat areavailableun ltheU.S.Censusbeginstoincludetransgenderasagendercategory.Withoutthesepopula on es mates,itisdiculttounderstandtheextenttowhichthetransgenderpopula onhasbeenimpactedbyHIVinLos AngelesCountyandtheamountofpreven onandcareresourcesweneedtoallocatetoaddresstheneedsofthis importantcommunity.

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