医学论文翻译实例

High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey 文章题目

就按顺序翻译看看与transgender people ；HIV相关的然后标注参考文献。可以大段翻译也可以有价值的句子单蹦翻译。这例子里面红色的是翻译的。字不用这么小看着英语费劲。。。

Abstract

Background: Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity.

背景:在这些跨性别人群中研究HIV相关的风险,往往是在MTF人群中。研究已经发现HIV 相关的风险行为,自我报告的HIV和血清阳性的HIV呈高流行率结果。

Results:Trans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions–25% of female-to-male (FTM) and 51% of MTF individuals–had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible.

在安大略省报告指出，这些变性的人群与各种类型的人都有广泛的性行为。在过去的一年高达25%的女变男(FTM)和51%的男变女（MTF）没有性伴侣。在这MTF中,19%的人去年有高危的性经历,而FTM为7%。最大的艾滋病风险行为诱因就是性行为。

总体而言,46%的人从未进行HIV检测,寿命测试发现，原住居民的变性人群寿命最高，非原住居民的变性人寿命最短。大约15%的人从事了性工作，大约2%的人目前从事性交易。

In a recent international meta-analysis of 25 studies from 14 countries [6], overall HIV prevalence was 27.3% in MTF sex workers versus 14.7% in MTFs not engaged in sex work, 15.1% in cisgender(non-trans) male sex workers, and 4.5% in cisgender female sex workers. Overall, MTF sex workers had a 4- fold increased risk of HIV infection compared with cisgender female sex workers. High prevalences have been observed even among youth. In a recent study of reported that 2% of FTMs in a San Francisco sample were HIV positive, versus 35% of MTFs 在最近的一项来自14个国家25项研究分析中,总体对于HIV患病率来说，MTF性工作者为27.3%，相对于不从事性工作的MTF 14.7%。男性（非变性）性工作者为15.1%，女性性工作者为4.5%。总的来说, 相对于女性性工作者，MTF性工作者有4倍之高的HIV感染

风险。甚至在青年中，这种高流行率也已得到关注。最近的一份研究报告指出, 在圣弗朗西斯2%的FTM样本是HIV阳性,而MTF为35%。

In the U.S., higher prevalences of HIV have been identified for African-American MTFs, with seroprevalences as high as 63% [1]. Summary measures from a meta-analysis estimate self-reported HIV positivity at 30.8% for African-American MTFs, and seroprevalence at 56.3% [3]. Considering historical and contemporary differences between the U.S. and Canada with regard to colonialism, slavery, immigration policies and patterns, and human rights policy, it is not clear to what extent ethno-racial inequities observed in the U.S. may apply in Canada. However, given the impact of experiences of racism, HIV vulnerability among racialized groups of trans people in Canada is a concern. Despite long- standing recognition of HIV vulnerabilities among Aboriginal Canadians, concerns regarding HIV among Aboriginal trans people have only begun to be addressed. Aboriginal people represented 3.8% of the Canadian population, 8% of all prevalent HIV infections, and 12.5% of all new infections in 2008 [10].

在美国,HIV的高流行率被认为是来自非裔美国人中的MTF，其血清阳性率高达63%[1]。从一项分析中的总结可估计，在非裔美国人MTF中HIV阳性达30.8%,血清阳性率达56.3%[3]。

加拿大人口的3.8%为原住居民,8%感染HIV, 而在2008年为12.5% [10]。

Studies have described behavioural sexual risk factors for HIV among MTFs in particular. These factors include compulsive sexual behaviour [11], sex work [11,12], multiple sex partners [1], unprotected receptive anal sex [13], and sex under the influence of drugs or alcohol [13]. Having sex with cisgender men who have sex with men [14], or having a partner of an unknown HIV status [15], were also documented risk factors for HIV.

研究报道了特别是在MTF中感染HIV高风险的性行为因素。这些因素包括强迫性性行为[11],性工作[11、12],多重性伴侣[1],无保护的肛交[13],药物和酒精影响下的性交[13]。和男男性交过的男性发生性关系[14],或有一个未知HIV状况性伙伴[15]。

Discussion

This study contributes significant and critical information to the literature addressing HIV-related risk in trans communities. First, the study uses respondent-driven sampling, which through design and analysis strategies minimizes biases associated with convenience sampling that are present in the published literature. The estimates of HIV-related risk behaviours are considerably lower than in studies where convenience samples were used.Trans people were also more heterogeneous with regard to sex partner numbers and types, as well as for the types of sex they engaged in, with the majority not at high risk for sexually acquired HIV within the past year.A high proportion (one quarter of FTMs and half of MTFs) did not have any past-year sex partners, contributing to low prevalences of high-risk sex.FTMs reported unprotected receptive genital sex and MTFs insertive genital sex as the most common high-risk behaviours. Unlike other studies, high-risk sex did not differ across ethno-racial groups, though HIV testing history did. Low rates of HIV testing among trans people in Ontario were reported, compared to other jurisdictions, with the lowest lifetime testing among non-Aboriginal racialized people and the highest among Aboriginal people. In addition, while the focus of previous studies suggests that sex

work is largely the purview of MTFs, in this study,MTFs and FTMs did not differ in both their historic and current engagement in sex work. Finally, prevalences of HIV infection were lower compared with other studies that used convenience sampling. Given low prevalences of testing and low statistical precision, however, estimates for self-reported HIV prevalence of 0.6% for FTMs and 3% for MTFs should be interpreted with caution.

这些跨性别的人也对性伴侣的数量和类型，以及他们发生性关系的类型均不相同，在近一年内大多数感染HIV的人没有处在高风险的性行为中。高比例的人数（四分之一的FTMS 和一半的MTF）过去一年没有任何性伙伴，从而有助于达到高危性行为的低流行率. FTMS 未受保护的生殖器性交和MTFs的插入生殖器性交是最常见的高危行为。

考虑到低检测率和低统计学精度,我们估计HIV自我报告率为FTM0.6%以及MTF3%,应该引起注意.

That our estimates for trans people were similar to the broad Ontario population with regard to education, region of residence, and birth within versus outside of Canada, support the success of our sampling method in reaching trans people broadly. However, trans people constitute a hidden population, and it is not known to what extent trans demographics actually mirror population demographics. To assume similarity would be to assume trans people are born at, transition at, immigrate at, and survive at rates proportionate to the population, and there are reasons to expect that this may not be true. Violence against trans people and suicide, in particular, have been recently raised as serious health and equity concerns [30-32]. These may seriously impact the survival of trans people, though little published research exists. Immigration, transition and survival may also explain, to some extent, the reduced ethno-racial diversity among MTFs in particular. However, it is also possible that these differences were created in the process of net- work-based data collection, through network structural factors, or differences in recruitment or participation across groups. Trans population estimates describe a population that is younger and has lower personal income than Ontarians broadly. A younger age distribution has been observed consistently across trans studies. This may in part explain low incomes, as income generally increases with age, however high levels of employment discrimination have been documented [33], and it is unlikely that low incomes are simply an age-related effect.

然而,这些跨性别人构成了一个隐蔽的人群,没有人知道这些人群真正的人口结构如何.

这些跨性别人口估计数表明了一个年龄较小, 相比其他安大略省的人较低的个人收入的人群。研究已发现这些人群呈年轻的年龄分布。这可能一定程度上解释了收入低的问题，随着收入随着年龄的增长而增长，更一层的就业歧视已经显露出[33],而且低收入不太可能仅仅是一个年龄相关的影响因素。

Existing trans-specific or trans-friendly services, while limited, are concentrated in Toronto. That two-thirds of trans people did not live in metropolitan Toronto illustrates the need for development of trans-friendly services in smaller Ontario cities and towns. A recent population-based study, using a broad definition of transgender, estimated that 0.5% of the adult Massachusetts population was trans [34]. While it is not clear how this estimate would apply to the Ontario population, as a population- based estimate it represents the best information to date. Applying this estimate to the 2008 population of 10,710,200 Ontario residents over age 15 [35] (to most closely match the 16-year age limit of our study), we would estimate that there are approximately 53,500 trans residents of Ontario, 36,000 of whom do not live in Toronto.

我们估计可能在安大略省大约有53500人为跨性别者，而36000人不居住在多伦多。

Self-reported HIV prevalence was estimated at 0.6% for FTMs and 3% for MTFs, higher than expected based on overall population estimates for Ontario. In 2008, there were an estimated 26,627 prevalent HIV infections in Ontario [36], for a 2008 population of 10,710,200 residents age 15 and over [35], representing an overall HIV prevalence of 0.25% or 1 in 400. Of these, it has been estimated that two-thirds, or about 0.17%, were aware of their HIV status [36]. Estimates from the current analysis are that 2% of trans people (1.7% without rounding) selfreport HIV positivity, 10 times the expected baseline value.However, given the width of the confidence intervals and the high proportion of trans people that had never been tested, it is not possible to accurately estimate HIV prevalence from these survey data. As in any study, there are limitations to this analysis. While estimates from RDS have been shown to be statistically unbiased [27], confidence intervals are wide. For this reason, point estimates should not be over-interpreted, but rather interpreted with regard to the range of plausible values.

自我报告的HIV感染率估计为FTMs 0.6%和3% MTFs,高于基于整体人口的安大略省预期估计值。对于一个2008年15岁或是超过15岁人口将达到10710200人的安大略省,估计有26627名HIV感染者流行,代表着HIV流行率为0.25%。其中,据估计,三分之二,或约0.17%,都了解自己的HIV状况(36)。从当前分析估计2%的跨性别者(真实为1.7%)自我报告HIV阳性。为预期值的10倍。

It is important to note that self-reported estimates are likely underestimates of actual HIV prevalence. About a quarter of trans people reported that they were unsure of their HIV status, and about half have never been tested.History of testing varied significantly by ethno-racial group, but not by gender spectrum. Only 15% of Aboriginal trans people had never been tested, versus 44% of non-Aboriginal white people and 67% of non-Aboriginal racialized people. While we were not able to determinewhy these differences may exist, it is possible that the higher testing rates in Aboriginal trans people result from inclusive campaigns targeting Two-Spirit people. Outside of Aboriginal communities, campaigns targeting MSM, for example, may not even seem relevant to trans MSM. It is also possible that the greater awareness of HIV-related issues in Canadian Aboriginal communities may also contribute to increased perception of risk by Aboriginal trans people or their health care providers.

重要的是,自我报告的估计值可能低估了实际的HIV流行率。大约四分之一的跨性别人不清楚自己的HIV状况，大约一半都没有检测过。

只有15%的原著跨性别人群从未进行检测过,而44%的白人和67%的非原住民则未进行过检测。

It is surprising that HIV testing was so low, given that it is free across the province of Ontario, and anonymous testing is available in most jurisdictions. As a comparison, despite similarities in estimates of partner types,MTF vs. FTM frequencies of sex, and transition status, a survey of trans people in Virginia found that only 18% had never been tested for HIV [37], versus 46% in our study. It has been argued that Canada’s punitive HIV non-disclosure laws, in place since 1998, may deter people from testing [38]. In the context of HIV testing services, barriers to inclusion can also occur due to erasure of trans people at the informational and institutional levels [21]. Erasure is the process through which trans people, and by extension trans communities, are systematically rendered invisible through passive or active exclusion,including the assumption that information

on trans people, or policies to accommodate them are not relevant [21]. As an example, for many years the largest anonymous HIV testing site in Ontario’s largest city had“men’s days” and “women’s days” and when to attend –and indeed the safety of attending – was unclear to potential users who were trans. It is not readily apparent which factors affect HIV testing, and to what extent non-testing is due to low risk of HIV versus barriers that prevent testing in moderate- to high-risk individuals.

奇怪的是艾滋病毒检测是如此之低,因为它在整个安大略省是免费的，而且在大多数地区匿名测试也是可以的。

一项调查显示,在弗吉尼亚跨性别人群众发现,只有18%的人从未进行过艾滋病毒检测[37],而46%在我们的研究中，一直以来加拿大从1998年开始的惩罚性的HIV保密法律备受争议,这可能会阻止人们进行测试[38]。