Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil / Descriptive study of homophobia and vulnerability to HIV/Aids of the transvestites in the Metropolitan Region of Recife, Brazil

O estudo buscou conhecer as vulnerabilidades ao HIV/Aids das travestis da Região Metropolitana do Recife. Optou-se por utilizar o método amostral conduzido pelo entrevistado, conhecido por Respondent Driven Sampling (RDS). Entre as 110 travestis foram encontrados altos índices de homofobia em locais como: serviços de segurança, locais de trabalho, ambiente familiar e religioso, vizinhança, escola, comércio, locais de lazer e nos serviços de saúde. Entre as situações de violência sofridas destacam-se a agressão verbal (81,8%) e física (68,2%). O teste de HIV realizado alguma vez na vida foi observado em 84,4%. Encontrou-se um alto nível de conhecimento sobre as formas de prevenção e transmissão da infecção pelo HIV. A maioria iniciou a vida sexual antes dos 15 anos e sem o uso do preservativo. No contexto da epidemia do HIV/Aids observa-se que as estratégias de promoção da saúde só poderão ser eficazes se forem considerados fatores que ampliam a compreensão da vulnerabilidade ao HIV/Aids, como a homofobia.

This study sought to ascertain the vulnerabilities to HIV/Aids of transvestites of the Metropolitan Region of Recife. The Respondent-Driven Sampling (RDS) method was selected for data collection. Among the 110 transvestites, high indices of homophobia were found in locations such as: security services, work facilities, family and religious environments, neighborhood, school, stores, leisure spaces, and healthcare services. Among the situations of violence experienced, the predominant cases involved verbal aggression (81.8%) and physical aggression (68.2%). The HIV test carried out at some stage in their lives was reported by 84.4% of the subjects. A high level of knowledge of the forms of HIV prevention and transmission was detected. The majority of the transvestites began their sexual activity before 15 years of age without condom use. It was seen that in the context of the HIV/Aids epidemic, the strategies for health promotion can only be effective if factors for enhancing the understanding of the vulnerability to HIV/Aids, such as homophobia, are considered.

[Descriptive study of homophobia and vulnerability to HIV/AIDS of the transvestites in the Metropolitan Region of Recife, Brazil]. / Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil.

This study sought to ascertain the vulnerabilities to HIV/Aids of transvestites of the Metropolitan Region of Recife. The Respondent-Driven Sampling (RDS) method was selected for data collection. Among the 110 transvestites, high indices of homophobia were found in locations such as: security services, work facilities, family and religious environments, neighborhood, school, stores, leisure spaces, and healthcare services. Among the situations of violence experienced, the predominant cases involved verbal aggression (81.8%) and physical aggression (68.2%). The HIV test carried out at some stage in their lives was reported by 84.4% of the subjects. A high level of knowledge of the forms of HIV prevention and transmission was detected. The majority of the transvestites began their sexual activity before 15 years of age without condom use. It was seen that in the context of the HIV/Aids epidemic, the strategies for health promotion can only be effective if factors for enhancing the understanding of the vulnerability to HIV/Aids, such as homophobia, are considered.

Gender dysphoria and cross-dressing in people with intellectual disability: a literature review.

In clinical practice, we have come across people with intellectual disability who have gender dysphoria and cross-dress. Here, we review the literature on this subject and present an illustrative case example. We searched databases, followed-up references from relevant articles, and contacted colleagues in the field. We found nine papers with case examples and one survey. Gender identity problems certainly occur in people with intellectual disabilities, and developmental perspectives are important in assessing and treating them. In some cases autistic spectrum disorder was co-morbid, for individuals with and those without intellectual disability. Aggression was also common. Documented treatments were primarily psychological and social and did not include hormones and sex reassignment surgery. Capacity to consent is a factor that determines treatment.

Conversion disorder in a pediatric transgender patient.

Somatoform disorders are difficult to diagnosis and often present as a neurological illness in pediatric populations. Conversion disorder is the somatoform disorder most commonly seen in children, particularly adolescents, who have anxiety related to sexual behaviors and orientation. In a transgender patient, the risk of conversion disorder is even higher. The patient described in this article presented with multiple neurological symptoms that disappeared after she began presenting herself as a male. There is a significant need for research into somatoform disorders as well as research into the transgender population.

Anorexia nervosa and gender identity disorder in biologic males: a report of two cases.

UNLABELLED: Gender identity disorder is a rare disorder of uncertain etiology. The emphasis on body shape in this disorder suggests that there may be an association with anorexia nervosa. METHOD: We report two cases of anorexia nervosa and gender identity disorder in biologic males who presented to an eating disorders service. RESULTS: One was treated successfully as an outpatient and subsequently underwent gender reassignment surgery. The other patient required admission and prolonged psychotherapy. DISCUSSION: Differences between the two cases are discussed. Issues of gender identity should be considered in the assessment of male patients presenting with anorexia nervosa.

Family cooccurrence of "gender dysphoria": ten sibling or parent-child pairs.

Ten (10) sets of siblings or parent-child pairs concordant for gender identity disorder (transsexualism) or gender identity disorder and transvestitism are reported. For concordant gender identity disorder, there is one set of male monozygotic twins; three sets of non-twin brothers; one brother-and-sister pair; one set of sisters; and one father and son. With gender identity disorder and transvestism, there is one transsexual father with a gender dysphoric; transvestic son; one transvestic father with a gender dysphoric, transvestic son; and one transvestic father with a transsexual daughter. The emerging technology of genetic markers makes collation of such families a potentially valuable resource for unraveling the origins of atypical gender identity.

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution]. / Características sociales y conductas de riesgo para el VIH en un grupo de travestis y transexuales masculinos que ejercen la prostitución en la calle.

OBJECTIVE: To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes. METHODS: Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected. RESULTS: 132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had). CONCLUSIONS: HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan.

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention.

Possible Asperger's syndrome in a mentally handicapped transvestite offender.

A 38-year-old man with a moderate mental handicap and Asperger's syndrome is described. His transvestism and history of offending behaviour is interpreted in the light of this.

Behavioural patterns and HIV infection among drug using transvestites practising prostitution in Rome.

Fifty-seven male prostitutes who were also drug users, underwent HIV-1 testing in a drug dependency unit in Rome. The overall prevalence of HIV antibody was 74% (42/57). Of the 57 subjects, 46 completed a standard questionnaire and were interviewed by a trained psychologist about use of drugs, sexual and AIDS-related behaviours. Among the 46 patients responding to the questionnaire, the prevalence of HIV was 67% (31/46). HIV prevalence increased with the duration of drug use, rising from 48% for less than 2 years use, to 64% for 2 to 4 years, and 100% for more than 4 years. It also increased with duration of stay in Italy: from 59% for less than 2 years, 78% for 2-4 years and to 83% for more than 4 years. Prevalence of HIV antibody was higher among those who reported injecting drugs (73% vs 63%), or who reported needle sharing (83% vs 62%). Higher prevalence was also related to the number of partners in the last year (74% for more than 1,500 partners vs 50% for less than 1,500), and to non-use of condoms (70% for 'sometimes/never' vs 50% for 'always'). The results indicate that further educational outreach efforts are required among male transvestite prostitutes since they may constitute a potential source of infection for their clients.

Buspirone hydrochloride in the treatment of transvestic fetishism.

The author presents a case report of a 46-year-old man with generalized anxiety disorder and transvestic fetishism who responded to treatment with buspirone. The patient stopped cross-dressing while taking buspirone, but alprazolam had no effect on the frequency of cross-dressing. The author discusses the implications of using buspirone in the treatment of both inhibited sexual desire and transvestic fetishism.

Preadult feminine behaviors of male transvestites.

Feminine behaviors during the childhood and adolescence of volunteer male transvestites who had shown a period of fetishism were investigated. The transvestites were categorized into two groups. Twenty who were satisfied with cross-dressing were termed nuclear transvestites, and 14 who desired at least a partial feminization were termed marginal transvestites. It was found that during their preadult years marginal transvestites showed significantly more feminine behaviors than nuclear transvestites, and both transvestite groups reported significantly more feminine behaviors than "normal" controls.

Tempral lobe epilepsy with diaper fetishism and gender dysphoria.

A 24-year-old right-handed man is described, who suffered grand-mal seizures since he was 18 months old. During childhood he preferred girls' games and company. At 10 years of age he began to dress in female clothes and wished to live as a woman. At 15 years of age he began to dress as a baby, wanting to evolve into a sophisticated woman. Examination showed the presence of constructional dyspraxia, and a partial left homonymous hemianopia. His CT head scan showed right cerebral hemiatrophy.

Erotic imagery and self-castration in transvestism/transsexualism: a case report.

After nearly 30 years of marriage, a 51-year-old man castrated himself in order to fulfill a long-standing fantasy of being a girl. There was a prior history of cross-dressing since childhood, and a reversed erotic role imagery during coitus. There was no history of schizophrenia or psychotic depression. Pair bonding with the wife was very strong. It led the patient to elect low-dose maintenance on androgen so as to permit some degree of continued marital sex. Otherwise the patient would have preferred estrogenization and, perhaps, eventual sex reassignment. The rehabilitative program as a transvestite man has continued for 3 years.

Amplification of the erotic enema deviance.

Use of enemas for sexual stimulation has been observed and named klismaphilia. Some klismaphiliacs indulge their taste for enemas in other wise normal sexual settings. Others combine it with fetishes, excretory and otherwise or with masturbation. Still others practice klismaphilia in homosexual or sadomasochistic settings or in group sex.

Successful lithium treatment of transvestism associated with manic-depression.

A case of transvestism in a 24-year-old manic-depressive man is described. The behavior had been maintained for 2 years and disappeared soon after lithium treatment was begun. It has not returned during the first year on lithium. Dynamic and behavioral explanations for this unusual therapeutic response are considered. The dynamic explanation involves the assumption that the transvestism was perpetuated by mood-dependent motives that were eliminated by lithium. The behavioral explanation involves the assumption that the manic state itself became an intermittent reinforcer for the transvestism, and the lithium, by eliminating the mania, created a relatively permanent extinction period.