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Transgender Women and HIV: What You Need to Know

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.

HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender identity or presentation, age, or income. But certain groups, like transgender women,1 have a greater chance of getting HIV than others. An estimated 14% of transgender women are HIV-positive.3

Many factors are linked to the high rate of HIV among transgender women. Among these are having sex without condoms or without other protection like medicines that prevent HIV, or having sex in exchange for drugs or money. Other factors include discrimination, unemployment, homelessness, violence, being in jail, drug and alcohol abuse, limited access to health care and prevention tools, and negative experiences with health care.

Know Your Status

About 1.1 million people in the United States are living with HIV. Of these people, one in seven do not know they are infected. Testing for HIV can give you important information. It can also help keep you — and others — safe. Knowing your HIV status can give you peace of mind. Testing is the only way you can know your status for sure. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. CDC recommends that people with certain risk factors get tested more often.

If you were HIV-negative the last time you were tested and you answer yes to any of the following questions, you should have an HIV test at least once a year. These factors increase your chances of getting HIV:

  • Have you had multiple sex partners?
  • Have you had sex—anal or vaginal3—with an HIV-positive partner?
  • Have you shared needles or syringes to inject drugs, hormones, steroids, or silicone?
  • Have you exchanged sex for drugs, money, or shelter?
  • Have you been diagnosed with or treated for a sexually transmitted disease (STD), such as chlamydia, gonorrhea, or herpes?
  • Have you been diagnosed with or treated for hepatitis or tuberculosis?
  • Have you had sex with someone who could answer yes to any of these questions? Have you had sex with someone whose sexual history you don’t know?

If you cannot answer yes to these questions but are sexually active, you should talk to a healthcare provider about how often you should get tested for HIV. A reasonable approach may include getting tested at least once a year.

Get tested for HIV regularly. If you visit your health care provider for hormone therapy, schedule an HIV test for the same time. Lab work for both tests often can be combined. Make HIV testing part of your regular health routine!

If You Are HIV-Negative—Staying Healthy and HIV-Negative

If you test negative for HIV, talk with your health care provider about ways to help you stay HIV-negative. There are more tools available to prevent HIV than ever before. Your health care provider may suggest taking PrEP (pre-exposure prophylaxis). You may also ask your provider about other HIV prevention methods. These include using condoms and choosing less risky kinds of sex. Since some prevention methods differ depending on your HIV status, such as PrEP or PEP, it is important to know your status by regularly testing for HIV.

If you do not have a provider, contact a community health center near you.

To learn more about PrEP, visit HIV, PrEP, and Transgender Women.

Visit the CDC HIV Risk Reduction Tool to get customized information about how your choices can help protect you against HIV.

What You Can Do To Protect Yourself From HIV

  1. Use condoms. Condoms are still one of the best ways to prevent getting or transmitting HIV and the only way to protect against some other STDs. There are different types of condoms. Find one that works for you and your partners. Use condoms all the time, with all of your sex partners.
  2. Use a lubricant with condoms during sex. Lubricant can be water-based or silicone-based. Use it during both vaginal and anal sex. Lubricant reduces the chances of breaking a condom. It also reduces the risk of vaginal or anal tearing or bleeding.
  3. Consider taking PrEP. If you think you might be at risk for getting HIV, ask your health care provider about PrEP. PrEP is a pill that you take every day to lower your chance of getting HIV. Learn more about PrEP for transgender women.
  4. Consider taking PEP in an emergency. If you think you have been exposed to HIV, contact your health care provider right away. You can also go to an emergency department or clinic. Ask for PEP (post-exposure prophylaxis). You should start taking it within 72 hours after you have been exposed to HIV. Learn more about PEP for transgender women.
  5. Don’t share needles, syringes, or other injecting equipment like spoons or swabs. HIV can live in a used needle for up to 42 days, depending on temperature and other factors.

If You Are HIV-Positive—Seeking Treatment

If you test positive for HIV, you should start HIV treatment right away. Antiretroviral therapy (ART) is HIV medicine that allows you to live a long, healthy life. Visit How to Protect Yourself and Others to learn more about ART, and for information on how to stay healthy. It also includes tips on talking with your partners about your HIV status and negotiating condom use.

Footnotes

  1. Transgender women is used here as an umbrella term to describe people who were listed as male on their birth certificate but who identify as women.
  2. Herbst J.H, 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;12(1):1-17.
  3. Information is lacking on how gender affirmation surgery that includes vaginoplasty may increase or decrease HIV transmission 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.
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.

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