Prevalence and clinical characteristics of HIV/sexually transmitted infections among transgender and gender-diverse individuals attending a gender-affirming clinic in Japan: A descriptive clinical-based study.

BACKGROUND

Transgender and gender-diverse (TGD) individuals face elevated risks of HIV and sexually transmitted infections (STIs). In Japan, limited access to comprehensive sex education and the legal sterilization requirement for gender change may contribute to gaps in prevention awareness. We examined HIV/STI prevalence and clinical characteristics among TGD individuals in clinical settings.

PATIENTS AND

METHODS

560 TGD individuals made their first visit to our clinic for gender-affirming care between January 2023 and December 2024. Among them, 275 (49%), all asymptomatic, underwent voluntary, free testing. Data on age, sex assigned at birth, sexual behaviors, STI history, and pre- or post-exposure prophylaxis (PrEP/PEP) use were obtained from clinical records and questionnaires. Descriptive analysis was stratified by sex assigned at birth (assigned male at birth [AMAB] and assigned female at birth [AFAB]).

RESULTS

Among 275 tested individuals (49 AMAB; 226 AFAB), HIV/STI positivity rates were 10.2% (5/49) for AMAB and 5.3% (12/226) for AFAB. Among valid responders, anal sex was reported by 65.6% (21/32) of AMAB and 10.2% (11/108) of AFAB. Positivity rates among those reporting anal sex were 14.3% (3/21) in AMAB and 36.4% (4/11) in AFAB.

CONCLUSION

While sexual behaviors varied widely among both AMAB and AFAB individuals, higher HIV/STI positivity rates were observed among those who reported anal sex; however, these findings are based on small numbers and should be interpreted as exploratory observations. To improve the sexual health of TGD individuals, health care providers should inquire about specific types of sexual practices. Tailored sexual health education is essential to support TGD communities.