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Transgendered and Sexual Health

Transgender is an umbrella term for persons whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth. Gender identity refers to one’s internal understanding of one’s own gender, or the gender with which a person identifies. Gender expression is a term used to describe people’s outward presentation of their gender.

Because data for transgender people are not uniformly collected, information is lacking on how many transgender people in the United States are infected with HIV. However, data collected by local health departments and scientists studying these communities show high levels of HIV and racial/ethnic disparities.

  • The numbers in the United States, it is estimated that almost 1 million adults identify as transgender.
  • Findings from a systematic review (Herbst et al.) of 29 published studies showed that 28% of transgender women had HIV infection (4 studies), while 12% of transgender women self-reported having HIV (18 studies). This discrepancy suggests many transgender women living with HIV don’t know their HIV status.
  • In the systematic review, black/African American transgender women were most likely to test HIV positive, compared to those of other races/ethnicities: 56% of black/African American transgender women had positive HIV test results compared to 17% of white or 16% of Hispanic/Latina transgender women.
  • Among the 3.3 million HIV testing events reported to CDC in 2013, the highest percentages of newly identified HIV-positive persons were among transgender persons.
  • Although HIV prevalence among transgender men is relatively low (0-3%), a 2011 study (Rowniak et al.) suggests that transgender men who have sex with men are at substantial risk for acquiring HIV.
HIV Testing Among Transgender Women and Men in 27 States and Guam, 2014–2015

Transgender persons are at high risk for human immunodeficiency virus (HIV) infection; in a recent analysis of the results of over nine million CDC funded HIV tests, transgender women had the highest percentage of confirmed positive results (2.7%) of any gender category. Transgender men, particularly those who have sex with cisgender men, are also at high risk for infection. READ MORE HERE

Prevention Challenges

Individual behaviors alone do not account for the disparate HIV diagnoses among transgender people. Many cultural, socioeconomic, and health-related factors contribute to these diagnoses and prevention challenges in transgender communities.

  • Sexual behaviors and factors that may contribute to the high risk of HIV infection among transgender people include receptive anal sex without a condom or medicines to prevent HIV, a high prevalence of HIV in sexual networks, sex with multiple partners, and exchanging sex for drugs or money.
  • Other factors that contribute to high rates of HIV among transgender people include drug and alcohol abuse, mental health disorders, incarceration, homelessness, unemployment, lack of familial support, violence, stigma, discrimination, limited health care access, and negative health care encounters.
  • Many transgender people face social rejection and marginalization that excludes them from participating and functioning in society. Lack of legal recognition of gender identity can result in the denial of educational, employment, and housing opportunities. Some transgender people who experience poverty rely on sex work to meet their basic survival needs.
  • Insensitivity to transgender identity can be a barrier for those who are diagnosed with HIV and seek quality treatment and care services. Research shows transgender women with diagnosed HIV infection are less likely to be on antiretroviral therapy (ART) or achieve viral suppression. Furthermore, few health care providers receive adequate training or are knowledgeable about transgender health issues and their unique needs.
  • Transgender-specific data are limited. Currently, many federal, state, and local agencies inaccurately collect data about individuals’ sex and gender. Using the two-step data collection method of asking for sex assigned at birth and current gender identity can help to increase the likelihood that transgender people will be accurately identified in HIV surveillance programs.
  • Behavioral HIV prevention interventions developed for other at-risk groups with similar behaviors have been adapted for use with transgender people; however, their effectiveness is still unknown. There is a need for effective interventions that address the multiple co-occurring public health problems in transgender persons.
  • Transgender men’s sexual health has been understudied. Additional research is needed to understand HIV risk behavior among transgender men, especially those who have sex with men.