Diagnoses of HIV Infection in the United States and Dependent Areas, 2018: Transgender Persons

Note: Additional gender identity not included due to small numbers. Numbers less than 12 should be interpreted with caution.
^a“Transgender male-to-female” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender female-to-male” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
^bHispanics/Latinos can be of any race.
^cData are based on residence at time of diagnosis of HIV infection.

Gender identity refers to a person’s internal understanding of their own gender, or gender with which a person identifies. HIV surveillance personnel collect data on gender identity, when available, from sources such as case report forms submitted by health care or HIV testing providers and medical records, or by matching with other health department databases (e.g., Ryan White program data). In May 2013, CDC issued guidance to state and local programs on methods for collecting data on transgender persons and working with transgender-specific data. However, characterization of HIV infection among transgender persons may require supplemental data from special studies. A person’s transgender status in NHSS is determined based on two variables – sex assigned at birth and current gender identity. Both variables are examined, using a two-step approach, to assess transgender status. Although not used in this report, cisgender is a term used to indicate that a person’s sex assigned at birth and current gender identity are the same (i.e., a person assigned male at birth and who currently identifies as a man, is a cisgender male).

Categories

• Male: persons assigned “male” sex at birth and current gender identity is not “transgender male-to-female” or “additional gender identity” (current gender identity can be listed as “male,” “female,” “transgender female-to-male,” “unspecified,” or left blank).
• Female: persons assigned “female” sex at birth and current gender identity is not “transgender female-to-male” or “additional gender identity” (current gender identity can be listed as “male,” “female,” “transgender male-to-female,” “unspecified,” or left blank).
• Transgender male-to-female (transgender MTF): persons assigned “male” sex at birth and current gender identity is “transgender male-to-female.”
• Transgender female-to-male (transgender FTM): persons assigned “female” sex at birth and current gender identity is “transgender female-to-male.”
• Additional gender identity (AGI): persons assigned “male” or “female” sex at birth and current gender identity is “additional gender identity.” AGI includes “bigender,” “gender queer,” and “two-spirit.”

In the Federal Register [6] for October 30, 1997, the Office of Management and Budget (OMB) announced the Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Implementation by January 1, 2003 was mandated. At a minimum, data on the following race categories should be collected:

• American Indian or Alaska Native
• Asian
• black or African American
• Native Hawaiian or other Pacific Islander
• white

Additionally, systems must be able to retain information when multiple race categories are reported. In addition to data on race, data on 2 categories of ethnicity should be collected:

• Hispanic or Latino
• not Hispanic or Latino

The Asian or Pacific Islander category displayed in annual surveillance reports published prior to the 2007 surveillance report was split into 2 categories: (1) Asian and (2) Native Hawaiian or other Pacific Islander. The Asian category (in tables where footnoted) includes the cases in Asians/Pacific Islanders (referred to as legacy cases) that were reported before the implementation of the new race categories in 2003 (e.g., cases of HIV infection that were diagnosed and reported to CDC before 2003 but that were classified as stage 3 [AIDS] after 2003) and a small percentage of cases that were reported after 2003 but that were reported according to the old race category (Asian/ Pacific Islander). In tables of diagnoses of HIV infection during 2014–2018, the Asian category does not include Asian/Pacific Islander cases because these cases were diagnosed after 2003 and were reported to CDC in accordance with OMB’s Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity [6].

This report also presents data for persons for whom multiple race categories are reported. In this report, persons categorized by race were not Hispanic or Latino. The number of persons reported in each race category may, however, include persons whose ethnicity was not reported.

AGI: additional gender identity

AIDS: acquired immunodeficiency syndrome

CDC: Centers for Disease Control and Prevention

FTM: female-to-male

HIV: human immunodeficiency virus

IDU: injection drug use

MSA: metropolitan statistical area

MSM: gay, bisexual, and other men who have sex with men

MTF: male-to-female

NHSS: National HIV Surveillance System

NIR: no identified risk factor

OI: opportunistic illness

OMB: Office of Management and Budget

PrEP: preexposure prophylaxis

PWID: persons who inject drugs