HIV and Transgender People: Prevention Challenges

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There are many prevention challenges that may impact the HIV health outcomes for some transgender people.

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Transphobic discrimination (transphobia) occurs when transgender people face stigma and oppression directed toward them. Findings from CDC’s National HIV Behavioral Surveillance (NHBS) report show that most transgender women have experienced some form of abuse or harassment because of their gender identity or presentation. This may negatively impact accessing testing, care, or getting treatment for HIV.

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HIV stigma may prevent transgender people from learning their HIV status. One study found that anticipated HIV stigma was associated with delaying regular HIV testing among some young transgender women.

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Racism and discrimination may increase HIV risk-related behaviors and lead to health disparities in HIV. According to a study, young minority transgender women experienced racial discrimination more often than young White transgender women. Issues associated with racism and discrimination—including limited access to health care, employment, and housing—can increase the risk for HIV and affect the health and well-being of transgender people.

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Transgender and other gender minority youth may be less likely to engage in HIV prevention and treatment services. One study found that transgender youth were more likely to miss HIV care appointments if they did not feel supported through medical gender affirmation or were treated negatively because of their gender identity. Understanding these factors may help improve engagement in HIV prevention and treatment services for transgender youth.

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Multilevel interventions for transgender people may be needed to address disparities. According to a 2017 review, evidence-based multilevel interventions that address the structural, biomedical, and behavioral risks for HIV among transgender women and men are needed to address HIV disparities. Evidence-based behavioral interventions for transgender women have been found to be effective and are included in CDC’s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention.

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Unmet need for gender affirmation, including not being on hormones, may impact or delay HIV treatment. A study found that unmet surgical needs and not being on hormones were significantly associated with HIV treatment interruptions. Similarly, another study found that hormone use lowered odds of not being on HIV treatment.

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