HIV and Transgender People
- A 2017 paper used meta-analysis and synthesized national surveys to estimate that nearly 1 million adults in the United Statesa are transgender.b
- From 2009 to 2014, 2,351 transgender people received an HIV diagnosis in the United States.c
- Eighty-four percent (1,974) were transgender women, 15% (361) were transgender men, and less than 1% (16) had another gender identity.
- Around half of transgender people (43%  of transgender women; 54%  of transgender men) who received an HIV diagnosis lived in the South.d
- A 2019 systematic review and meta-analysis found that an estimated 14%external icon of transgender women have HIV. By race/ethnicity, an estimated 44% of black/African Americane transgender women, 26% of Hispanic/Latinaf transgender women, and 7% of white transgender women have HIV.g
- Among the 3 million HIV testing eventsh reported to CDC in 2017, the percentage of transgender people who received a new HIV diagnosis was 3 times the national average.
- Nearly two thirds of transgender women and men surveyed by the Behavioral Risk Factor Surveillance System (BRFSS) in 2014 and 2015 from 28 jurisdictions reported never testing for HIV.
HIV Diagnoses Among Transgender People in the United Statesc by Race/Ethnicity, 2009-2014
There are numerous prevention challenges that may impact the HIV health outcomes for some transgender people. These include:
- Certain behaviors and socioeconomic factors can affect outcomes, such as having multiple sex partners, anal or vaginal sexi without protectionj (like a condom or medicine to prevent or treat HIV), and sharing needles or syringes to inject hormones or drugs. Additional factors include commercial sex work, mental health issues, incarceration, homelessness, unemployment, and high levels of substance misuse compared to the general population.
- HIV behavioral interventions developed for other at-risk groups have been adapted for use with transgender people. However, the effectiveness of these interventions is understudied. According to a 2017 study, most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Evidence-based multilevel interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence.
- Many transgender people face stigma, discrimination, social rejection, and exclusion that prevent them from fully participating in society, including accessing health care, education, employment, and housing, as well as violence and lack of family support. These factors affect the health and well-being of transgender people, placing them at increased risk for HIV.
- Transgender women and men might not be sufficiently reached by current HIV testing measures. Tailoring HIV testing activities to overcome the unique barriers faced by transgender women and men might increase rates of testing among these populations.
- Transgender men’s sexual health has not been well studied. Transgender men, particularly those who have sex with cisgender (persons whose sex assigned at birth is the same as their gender identity or expression) men, are at high risk for infection. Over half of transgender men with diagnosed HIV infection had no identified or reported risk. Additional research is needed to understand HIV risk behavior among transgender men, especially those who have sex with other men.
- Lack of knowledge about transgender issues by health care providers can be a barrier for transgender people who receive an HIV diagnosis and are seeking quality treatment and care services. Few health care providers receive proper training or are knowledgeable about transgender health issues and their unique needs. This can lead to limited health care access and negative health care encounters.
- Transgender women and men might not fully engage in medical care. In a studyexternal icon of transgender men with HIV who were receiving medical care, 60% had maintained an undetectable viral load over the previous 12 months. A 2015 studyexternal icon found that 50.8% of transgender women who were receiving medical care had maintained an undetectable viral load over the previous 12 months. Taking HIV medicine as prescribed and keeping an undetectable viral load (or staying virally suppressed) is the best thing people with HIV can do to stay healthy and protect their sexual partners. People with HIV who keep an undetectable viral load have effectively no risk of sexually transmitting HIV to an HIV-negative partner.
- Transgender and other gender minority youth are an at-risk group understudied in HIV prevention (e.g., PrEP) and HIV treatment. But one studyexternal icon of transgender youth found that medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments.
- Transgender-specific data are limited. Some federal, state, and local agencies do not collect or have complete data on transgender individuals. Using the two-step data collection methodexternal icon of asking for sex assigned at birth and current gender identity can help increase the likelihood that transgender people are correctly identified in HIV surveillance programs. Accurate data on transgender status can lead to more effective public health actions.
What CDC Is Doing
CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods among transgender people. Activities include:
- In 2017, CDC awarded nearly $11 million per year for 5 years to 30 CBOs to provide HIV testing to young gay and bisexual men of color and transgender youth of color, with the goals of identifying undiagnosed HIV infections and linking those who have HIV to care and prevention services.
- As part of its Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention, CDC recently identified the Couples HIV Intervention Program pdf icon[PDF – 988 KB] as an evidence-based intervention that focuses on transgender women and their primary cisgender male partners. The goals of the intervention are to reduce HIV risk behaviors, improve relationship communication, and improve partner interpersonal dynamics.
- CDC supports health department demonstration projects that provide pre-exposure prophylaxis (PrEP) support services and data-to-care activities prioritizing gay and bisexual men and transgender people at substantial risk for acquiring HIV, particularly people of color.
- CDC is funding a National HIV Behavioral Surveillance (NHBS) activity among transgender women that will use NHBS methods to conduct a behavioral interview and HIV testing among transgender women in 7 NHBS sites.
- CDC provides support and technical assistance to health departments, CBOs, and providers to support interventions for transgender people (e.g., condom distribution, community mobilization, HIV testing, and coordinated referral networks and service integration).
- Through its Capacity Building Assistance initiative, CDC works with the Center of Excellence for Transgender Health to support National Transgender HIV Testing Day. This day promotes HIV testing, prevention, and treatment efforts among transgender people.
- CDC developed communication materials to reach transgender people through its Let’s Stop HIV Together campaign. Let’s Stop HIV Together includes resources and partnerships aimed at stopping HIV stigma and promoting HIV testing, prevention, and treatment. The stigma materials include stories and issues relevant to transgender people.
a Includes 50 states and the District of Columbia.
b These data may under report HIV diagnoses among transgender people because of challenges in accurately identifying and reporting gender identity in HIV surveillance.
c Includes 45 states plus the District of Columbia.
d Includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
e Black refers to people having origins in any of the black racial groups of Africa, including immigrants from the Caribbean, and South and Latin America. African American is a term often used for Americans of African descent with ancestry in North America. Individuals may self-identify as either, both, or choose another identity altogether.
f Hispanics/Latinas can be of any race.
g Estimate for transgender women overall includes laboratory-confirmed infections only. Estimates by race/ethnicity include laboratory-confirmed and self-reported infections.
h 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.
i Information is lacking with regards to how sex reassignment surgery such as vaginoplasty, metoidioplasty or phalloplasty, for example, may increase or decrease HIV transmission risk.
j It is important to avoid assumptions regarding the types of sexual activity that transgender people engage in or how they may refer to their body parts.
For more information, visit CDC’s Lesbian, Gay, Bisexual, and Transgender Health website.
- 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, 2006–2017external icon. AmJ Public Health 2018. e1-e8.
- Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysisexternal icon. Lancet Infect Dis 2013;13(3):214-22.
- Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalizationexternal icon. Am J Public Health 2012;102(9):1751-7.
- Herman, JL, Flores, AR, Brown, TNT, Wilson, BDM, & Conron, KJ (2017). Age of individuals who identify as transgender in the United States pdf icon[PDF – 486 KB]external icon. Los Angeles, CA: The Williams Institute. Accessed January 28, 2019.
- CDC. CDC-funded HIV testing: United States, Puerto Rico, and U.S. Virgin Islands, 2015 pdf icon[PDF – 2 MB]. July 2017. Accessed January 28, 2019.
- CDC. Funding opportunity announcement: PS15-1502: Comprehensive high-impact HIV prevention projects for community-based organizations. Accessed January 28, 2019.
- CDC. Funding opportunity announcement: PS15-1506: Health department demonstration projects to reduce HIV infections and improve engagement in HIV medical care among men who have sex with men (MSM) and transgender persons. Accessed January 28, 2019.
- Chen S, McFarland W, Thompson HM, Raymond HF. Transmen in San Francisco: what do we know from HIV test site data?external icon AIDS Behav 2011;15:659-62.
- 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, 2009-2014external icon. December 2016. Accessed January 28, 2019.
- De Santis JP. HIV infection risk factors among male-to-female transgender persons: a review of the literatureexternal icon. J Assoc Nurses AIDS Care 2009;20(5):362-72.
- Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? pdf icon[PDF – 575 KB]external icon Los Angeles, CA: The Williams Institute. June 2016. Accessed January 28, 2019.
- Garofalo R, Johnson AK, Kuhns LM, Cotton C, Joseph H, Margolis A. Life Skills: evaluation of a theory-driven behavioral HIV prevention intervention for young transgender womenexternal icon. J Urban Health 2012;89(3):419-31.
- Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic reviewexternal icon. AIDS Behav 2008;12(1):1-17.
- Hotton AL, Garofalo R, Kuhns LM, and Johnson AK. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender womenexternal icon. AIDS Educ Prev 2013;25(1):62-71.
- James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M.. The Report of the 2015 U.S. Transgender Survey pdf icon[PDF – 2 MB]external icon. Washington, DC: National Center for Transgender Equality; 2016.
- Meerwijk EL, Sevelius JM. Transgender population size in the United States: a meta-regression of population-based probability samplesexternal icon. Am J Public Health 2017; 107(2):e1-e8.
- Mizuno Y, Frazier EL, Huang P, Skarbinski J. Characteristics of transgender women living with HIV receiving medical care in the United Statesexternal icon. LGBT Health 2015;2(00):1-7.
- New York City Department of Health and Mental Hygiene. Surveillance slide sets: HIV among people identified as transgender in New York City, 2011-2015external icon. December 2016. Accessed January 28, 2019.
- Nuttbrock L, Hwahng S, Bockting W, et al. Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender personsexternal icon. J Acquir Immun Def Syndr 2009;52(3):417–21.
- Reisner SL, Perkovich B, and Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender menexternal icon. AIDS Patient Care STDS 2010;24(8):501-13.
- Rowniak S, Chesla C, Rose CD, Holzemer WL. Transmen: the HIV risk of gay identityexternal icon. AIDS Educ Prev 2011;23(6):508-20.
- Sanchez T, Finlayson T, Murrill C, Guilin V, Dean L. Risk behaviors and psychosocial stressors in the New York City House Ball community: a comparison of men and transgender women who have sex with menexternal icon. AIDS Behav 2010;14:351-8.
- HIV testing among transgender women and men — 27 states and Guam, 2014–2015. MMWR 2017;66:883–887.
- Lemons A, Beer L, Finlayson T, Hubbard McCree D, Lentine D, Shouse RL. Characteristics of HIV-positive transgender men receiving medical care: United States, 2009–2014external icon. Am J Public Health 2018;108(1):128-30.
- Reisner SL, Jadwin-Cakmak L, White Hughto JM, Martinez M, Salomon L, Harper GW. Characterizing the HIV prevention and care continua in a sample of transgender youth in the U.S.external icon AIDS Behav. 2017; 21(12):3312-3327.
- Poteat T, Malik M, Scheim A, Elliott A. HIV prevention among transgender populations: knowledge gaps and evidence for actionexternal icon. Curr HIV/AIDS Rep. 2017;14(4):141-152.
- Mizuno Y, Frazier EL, Huang P, Skarbinski J.Characteristics of transgender women living with HIV receiving medicalcare in the United States.external icon LGBT Health. 2015;2(3):228-34.
- National Center for Transgender Equality; Annual report 2016. the t’s not silent. pdf icon[PDF – 3 MB]external icon