HIV Among Transgender People
April 18, 2016
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.
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.
What CDC Is Doing
CDC and its partners are pursuing a high-impact prevention approach to achieve the goals of the National HIV/AIDS Strategy: Updated to 2020 and maximize the effectiveness of current HIV prevention methods among transgender people. Activities include:
* An HIV testing event is one or more HIV tests performed with a person to determine that person's HIV status. During one testing event, a person may be tested once or multiple times.
For more information, visit CDC's Lesbian, Gay, Bisexual, and Transgender Health website.
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.
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