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For Health Care Providers

A four-panel collage of Transforming Health photos featuring transgender people. Three panels show individuals speaking with health professionals. One panel shows an individual filling out a form.

Research on transgender people and their health needs is sparse. However, studies reveal high HIV prevalence among transgender women in the United States. A 2008 systematic review found that the estimated HIV prevalence among transgender women in the United States was nearly 28%.1 Among Black/African American transgender women, the number living with HIV is estimated to be as high as 56% compared with 17% of White and 16% of Hispanic/Latino transgender women.2 A more recent analysis of surveillance data from 2009–2014 confirms these racial disparities, indicating that transgender women of color experienced the majority of new diagnoses. In that 5-year period, 51% of new diagnoses were among Black/African American transgender women, 30% were among Hispanic/Latino transgender women, and 11% were among White transgender women. The majority of transgender women newly diagnosed was under the age of 34, and a plurality resided in the south.3 In addition, studies indicate that transgender people may experience multiple health disparities due to stigma, discrimination, and unique barriers to accessing quality care. 4, 5

Transgender men are people who were listed as female on their birth certificate but who identify as men. While data on HIV among transgender men are limited, here is what is known:

  • In a research synthesis conducted by Reisner et al., HIV prevalence estimates for transgender men range from 0-4%.
  • HIV may disproportionately affect Black/African American transgender men compared to transgender men of other races. In a sample of 361 transgender men diagnosed with HIV, 58% were Black/African American, compared to 15% Hispanic or Latino and 16% White.
  • Some transgender men identify as gay men and are sexually active with cisgender men who have sex with men. These transgender men may have a particularly high risk of acquiring HIV.
  • Vaginal atrophy from testosterone therapy or oophorectomy may increase transgender men’s HIV acquisition risk

A Note on Terminology

Transgender is used here as an umbrella term to describe people who have a gender identity that is different from their sex listed on their birth certificate. Gender identity is on a spectrum. It is important to keep in mind that although some transgender people prefer the binary classification of men or women, many reject it. Instead, they may have other identities, such as non-binary, gender expansive, genderqueer, or trans-feminine/trans-masculine. These terms emphasize a broader view of gender and may provide a more nuanced understanding of what it means to be a transgender person.

A note regarding HIV research published in academic journals: An important consideration in research with transgender people is the challenge to accurately classify transgender women for surveillance/research purposes. Not all jurisdictions collect data on gender identity that include transgender people, and some researchers may use older methods that can misclassify transgender women as men who have sex with men. This can also happen as some transgender people may not identify themselves as transgender in health care settings due to fear of discrimination or previous negative experiences. This mix of limitations can result in over- or under-estimating the number of transgender people. As such, it is important to consider methodologies when interpreting data and surveillance findings. As the field is developing newer and more precise ways to identify transgender identity for research and surveillance purposes, it is important to consider methodological approaches, particularly for studies that include both men who have sex with men and transgender women. The most accurate method uses a two-step process, including two questions: “What is your current gender?” AND “What sex were you listed as at birth?” The large majority of studies cited in this document use a two-step process, however one is a meta-analysis and likely includes studies with a one-step process to determine gender identity. For more information about using a two-step process, please refer to the section Collecting Sexual Orientation and Gender Identity.

1 James SE, Herman JL, Rankin S, et al. The report of the 2015 U.S. Transgender Survey. http://www.transequality.org/sites/ default/files/docs/USTS-Full-Report-FINAL.PDF. Washington, DC: National Center for Transgender Equality; 2016.
2 Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014. AIDS Behav (2017) 21:2774–2783.

Footnotes

  1. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N; HIV/AIDS Prevention Research Synthesis Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008 Jan; 12(1):1-17.
  2. Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014. AIDS Behav (2017) 21:2774–2783.
  3. National Academy of Medicine. The health of lesbian, gay, bisexual, and transgender (LGBT) people: building a foundation for better understanding. Washington, DC: National Academies Press; 2011. Available from: www.nap.edu/catalog.php?record_id=13128
  4. Pew Research Center. A survey of LGBT Americans [Internet]. 2013, Jun 13 [cited 2016 Dec 14]. Available from: http://www.pewsocialtrends.org/2013/06/13/a-survey-of-lgbt-americans/
  5. Grant J, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey [Internet]. Washington, DC: National Center for Transgender Equality and
    National Gay and Lesbian Task Force. 2011. [cited 2016 Aug 31]. 220 p. Available from: http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf

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