For Health Care Providers
Transgender women and men are at high risk for getting HIV. According to current estimates, about 1 in 7 (14%) transgender women have HIV, and the percentage is much higher among black/African American (44%) and Hispanic/Latina (26%) transgender women.* An estimated 3% of transgender men have HIV.
Expanding culturally appropriate, focused HIV testing efforts is one key to eliminating these disparities and reducing HIV’s impact on transgender communities. Everyone with HIV benefits from getting a diagnosis as early as possible and starting treatment right away. People with HIV who take antiretroviral therapy as prescribed and stay virally suppressed can live long, healthy lives and have effectively no risk of sexually transmitting HIV to partners. For people at risk of getting HIV but who do not have the virus, testing can be the door to effective prevention options like pre-exposure prophylaxis (PrEP).
Many transgender people face obstacles that make it harder to access HIV services—such as stigma and discrimination, inadequate employment or housing, and limited access to welcoming, supportive health care. Addressing these barriers is essential to the health and well-being of transgender people.
The Centers for Disease Control and Prevention (CDC) is committed to working with health care providers to make sure all transgender people can get the tools they need to prevent HIV and stay healthy if they have HIV. Transforming Health gives providers tools for delivering patient-centered HIV care for all transgender patients.
*Estimates for transgender women overall and transgender men include laboratory-confirmed infections only. Estimates by race/ethnicity include laboratory-confirmed and self-reported infections.
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.
3 Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. AmJ Public Health 2018. e1-e8.
- 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.
- 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.
- 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
- 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/
- 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
- Page last reviewed: April 16, 2019
- Page last updated: April 16, 2019
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