HIV Disproportionately Affects Transgender People

Doctors know that certain groups of people have higher rates of HIV. In the United States, for example, people of transgender experience (also called trans or transgender people) are much more likely to be affected by HIV than the general population. This is especially true for trans women of color. Fewer studies have looked at HIV rates in transgender men. But trans men are also more likely to have HIV than the general population.^1,2

There are a few reasons why transgender people are more vulnerable to HIV. Most stem from stigma, discrimination, abuse, and harassment:^1,3

• Lack of access to gender-affirming healthcare: People of transgender experience may not trust the healthcare system. They may have encountered insensitive or unsupportive healthcare workers. This distrust can lead to missed appointments for gender-affirming care or surgery. It may also cause interruptions in HIV treatment.
• High-risk behaviors: Stigma, high rates of unemployment, and social isolation contribute to high-risk behaviors. These behaviors include unprotected sex, sex with multiple partners, sex work, and drug use. All can contribute to HIV transmission.
• Needle sharing: Lack of access to healthcare and substance misuse contribute to needle sharing. This could be for hormone injections or recreational drugs.
• Employment and housing: Trans people experience high rates of unemployment and lack of permanent housing. This is especially true of trans women. And poverty and homelessness are linked to higher rates of HIV.

Transgender women and HIV

A 2021 study from the US Centers for Disease Control and Prevention (CDC) included 1,608 transgender women. More than 4 in 10 had HIV. Women of color were hardest hit:¹

• 62 percent of Black trans women had HIV
• 35 percent of Hispanic trans women had HIV
• 17 percent of white trans women had HIV

Transgender women living in certain cities had higher rates of HIV. These cities included:¹

• Atlanta
• New York City
• Philadelphia
• New Orleans
• San Francisco
• Los Angeles
• Seattle

Transgender men and HIV

One of the few studies to look at rates of HIV among transgender men included 577 trans men in New York City. Of these men, nearly 3 in 100 had HIV compared to the US national average of less than 1 in 200.^2,3

Like other men who have sex with men, transgender men who have sex with men are at increased risk of getting HIV if they engage in risky behaviors. These behaviors include:²

• Receptive anal sex without a condom
• Sex with partners who are HIV positive or of unknown status
• Drug use during sex (chem sex)

Of the 577 trans men, less than half had ever been screened for HIV. This is despite the fact that they were receiving care at a clinic focused on gender-affirming care. Race or ethnicity did not seem to play a role in who had HIV, but the study was small. Other studies report HIV being more common in transgender men who are Black and Hispanic.²

Reducing HIV rates among people of transgender experience

There are nearly 1 million transgender people in the United States. Nearly 1 in 10 is HIV positive. This is much higher than the national average. It is important to understand why trans people are more likely to have HIV if we are to reduce future transmissions. In the meantime, the CDC recommends these practices known to reduce HIV transmission:^1,3

• Collecting data about sex and gender identity when counting new cases of HIV transmission and viral suppression
• More funding for studies that look at behaviors that contribute to HIV transmission risk, testing issues, and prevention services specific to the transgender community
• Inclusive education about safe sex practices
• Greater availability of PrEP (pre-exposure prophylaxis)
• Consistent availability of HIV medicines so viral load remains undetectable
• Regular HIV testing

Current and proposed anti-LGBTQ laws limit transgender people’s civil rights. These laws have the potential to increase risk of poor health among people of transgender experience. Some states are limiting trans people's access to:

• Medically necessary healthcare
• Gender-affirming care
• Insurance

Other bills weaken laws that keep employers, companies, and hospitals from treating LGBTQ people unequally. To reduce HIV in the transgender community, civil rights must be protected.⁴