In the name of brevity: The problem with binary HIV risk categories

• Published in: Global public health Vol. 11; no. 7-8; pp. 824 - 834
• Main Authors: Kaplan, Rachel L., Sevelius, Jae, Ribeiro, Kira
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-08-2016; Taylor & Francis Ltd; Taylor & Francis (Routledge)
• Subjects: Anal intercourse; At risk; Beirut; Best practice; Bisexuality; Categories; Clinical practice guidelines; Confusion; Cost analysis; Cost effectiveness; Cross-Cultural Comparison; Cultural Diversity; Disease prevention; Effectiveness; Epidemics; Female; Females; Gender; Gender Identity; Global Health; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; HIV risk prevention; Homosexuality; Homosexuality, Male; Human immunodeficiency virus; Humanities and Social Sciences; Humans; Lebanon - epidemiology; Male; Medical diagnosis; Medical treatment; MSM; Populations; Prevention; Prevention programs; Preventive medicine; Risk; Risk Assessment - methods; Risk Assessment - standards; Risk Assessment - statistics & numerical data; Risk factors; San Francisco - epidemiology; San Francisco; Sex; Sex education; Sexual Behavior - classification; Sexual Behavior - ethnology; Sexual Behavior - statistics & numerical data; Sexuality; Social Identification; trans women; Transgender persons; Transgender Persons - psychology; Transgender Persons - statistics & numerical data; Transsexuality; Treatment programs; Lebanon; Beirut Lebanon; San Francisco California; United States > US; San Francisco; HIV risk prevention; Beirut; trans women; MSM
• ISSN: 1744-1692; 1744-1706
• DOI: 10.1080/17441692.2015.1136346

According to the 'Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations' there are five groups of people at elevated risk of HIV, including 'transgender women or transgender men who have receptive anal sex with men'. Although cost effectiveness strategies and best practice lessons recommend targeting specific populations for HIV prevention, existing risk categories lack specificity, and may in fact cause further confusion. Existing categories of risk often perpetuate notions of gender and sexuality that can erroneously exclude, alienate, and stigmatise those who are at the highest risk and thus should be prioritised. We review the troubled history of the MSM category and the problematic conflation of trans feminine individuals and MSM in much of the existing HIV literature, and how this practice has stymied progress in slowing the HIV epidemic in the most at-risk groups, including those who do not fit neatly into binary notions of gender and sex. We draw from examples in the field, specifically among trans feminine people in Beirut and San Francisco, to illustrate the lived experiences of individuals whose identities may not fit into Euro-Atlantic constructs of HIV prevention categories.