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Transgender Women Living With HIV

September 11, 2018

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Table of Contents


Bearing a Huge Burden

Living With HIV

Across the globe, transgender women (trans women) are affected by HIV to a much greater degree than other groups. The World Health Organization (WHO) estimates that the proportion of trans women living with HIV is 49 times higher than in the general adult population. This is true whether trans women are living in low-, middle-, or high-resource countries. Worldwide, the prevalence of HIV among trans women is about 19 percent; this means that 19 out of 100 trans women in a given population will be living with HIV. By comparison, the global estimate of HIV prevalence among female sex workers is 12 percent, and the estimate for men who have sex with men is 13 percent. The overall global estimate of HIV prevalence is 0.8 percent.

The US Centers for Disease Control and Prevention (CDC) reported that transgender people are diagnosed with HIV three times more often than the general population. As in the cisgender (non-transgender) population, transgender people of color are many times more likely to be living with HIV than their white counterparts. From 2009-2014, 84 percent of new HIV diagnoses in the transgender community occurred among transgender women. CDC estimates that over half of African American transgender women live with HIV, compared to a quarter of all transgender women.


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Not Being Seen or Served

Despite bearing such a high burden of HIV, trans women have been historically underserved as part of the response to the HIV pandemic. Often, transgender women are not even ‘seen' because they are combined incorrectly into other categories, such as men who have sex with men. Existing data systems often do not ask the right questions about people's sex and gender and therefore do not count transgender individuals. It can also be challenging to 'see' transgender women because, due to past negative experiences or fear of discrimination, many trans women choose not to identify as transgender when they seek services.


The Good News

In the past few years, organizations have become more aware of how ill-served the transgender population has been by the global response to the HIV epidemic, and changes are (slowly) being made. WHO conducted a study and published guidelines on HIV prevention and care that included specific recommendations for transgender people. It also issued a policy that encourages countries to establish laws that decriminalize nonconforming gender identities, protect against discrimination, and work toward legal recognition for transgender people. According to Kate Montecarlo, founder and chair of the Association of Transgender People in the Philippines, the WHO made a "remarkable imprint on history when it comes to transgender health and HIV advocacy among transgender women -- in particular separating transgender people from men who have sex with men" and acknowledging the specific health needs of transgender people.


Issues Common to Trans Women

There are many intersecting issues common to transgender women that can make life challenging and make it more difficult for them to access the care they need. These include a range of social and structural inequalities that negatively affect the health outcomes of trans women living with HIV. As the National Center for Transgender Equality (NCTE) explains, "transgender and gender non-conforming people face injustice at every turn: in childhood homes, in school systems that promise to shelter and educate, in harsh and exclusionary workplaces, at the grocery store, the hotel front desk, in doctors' offices and emergency rooms, before judges and at the hands of landlords, police officers, health care workers and other service providers." For more information on some of these issues, see below.


Stigma, Discrimination, and Violence

The stigma and discrimination faced by people living with HIV is fairly well documented and understood. Studies have shown that stigma and discrimination -- or the fear of them -- keep people living with HIV from getting tested for HIV, getting linked to or having access to care, staying in care, getting HIV drugs, and taking their HIV drugs correctly (adherence).

In a 2011 survey of 6,400 transgender people, 63 percent reported having experienced discrimination serious enough to affect their ability to support themselves financially and emotionally. Transgender women of color, especially African-American trans women, bear the heaviest burden of discrimination. This is probably so because the combined effect of anti-transgender bias and structural racism is greater than the sum of their separate effects.

Serious discriminatory events can often be traumatic, leading to lasting negative effects on a person's ability to function in the world -- physically, mentally, emotionally, socially, and/or spiritually.

In Peru, before making the transition, I was the victim of much bullying for being a queer person and quite feminine. And the police attacked me. Once I was leaving a nightclub and a policeman stopped me. He took me to a parking lot far away, on the beach, put a gun to my head and sexually abused me. Then he left me on the beach. There were other incidents."

-- Arianna Lint, "Real Trans Latina History"

The negative feelings and sense of rejection that come from experiencing discrimination can also lead to low self-esteem, social isolation, depression, and even thoughts or acts of suicide. The survey reported that an astonishing 40 percent of survey participants had attempted suicide.

If you are thinking of hurting yourself or committing suicide, please tell someone immediately. In the U.S., you can call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). To find a suicide hotline near you, try www.suicide.org/suicide-hotlines.html; this website lists U.S. hotlines by state as well as hotlines by country (click on the "International Hotlines" link at the top of the main page).

Transgender people worldwide face extraordinary levels of physical and sexual violence. The National Coalition of Anti-Violence Programs reported that, in the US in 2013, severe hate-based violence against transgender people, people of color, and HIV-affected people was alarmingly high. Trans women were six times more likely to experience physical violence when interacting with police than survivors of violence in general. Violence, like stigma and discrimination, can result in trauma and lead to lasting negative effects on a person's ability to function and remain healthy.

Importantly: If you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the U.S. at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)]. You can also search for a safe space online at Domestic Shelters. If you live outside the U.S., please go to the Hot Peach Pages to find help near you. You can also search for shelters and services at SAFE (Stop Abuse for Everyone).

It is important to remember that, if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated to the point that they believe that they deserve whatever abuse comes their way. This is NEVER true.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
 

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