HIV is a virus that attacks the immune system and can increase the risk of other infections. Without treatment, HIV can progress to AIDS. Transgender women are at a higher risk of acquiring HIV due to multiple risk factors and may also have difficulty accessing sufficient care.
While simple interventions that can help to greatly reduce the spread of HIV and save lives are available, barriers such as health inequities often prevent transgender women from receiving the help and treatment they require. A variety of factors, such as discrimination, economic vulnerability, and a lack of support, typically affects the access they may have to healthcare and HIV services.
This article will discuss why transgender women are at higher risk and suggest prevention tips. It will also discuss potential barriers for support and how transgender women may access HIV treatment.
According to the
A report from the CDC further adds that racial and ethnic disparities exist among transgender women living with HIV. In the report, among the transgender women interviewed,
- 65% among American Indian/Alaska Natives
- 62% among Black people/African Americans
- 38% among those with multiple races
- 35% among Hispanic and Latina people
- 20% among Asian people
- 17% among Native Hawaiian/other Pacific Islanders
- 17% among white people
From 2015–2019, the number of HIV infection diagnoses among transgender adults and adolescents increased in the U.S. In 2019, 93% of HIV diagnoses among transgender adults and adolescents occurred among transgender women. By age, the largest group to receive a HIV diagnosis was transgender women aged 20–24 years (24%), followed by transgender women aged 25–29 years (23%).
A number of factors may put transgender women at higher risk of contracting HIV. Some of these factors may
The stigmatization of transgender individuals can produce discrimination at structural, interpersonal, and individual levels. This can then also increase the vulnerability of transgender women to HIV.
Racism and discrimination may
Discriminatory healthcare professionals can also deter transgender women from seeking medical advice and can act as a barrier to HIV prevention. This may also result in some people seeking treatments from unlicensed professionals, which could lead to reuse or sharing of needles and potential exposure through nonsterile medical equipment.
The National LGBTQ Task Force notes that transgender workers report unemployment at double the rate of the population as a whole. It also notes that transgender workers are at greater risk of unemployment and poverty.
Lack of housing, medical care, and employment may lead to transgender women having to rely on sex work. This may increase the risk of contracting HIV.
Transgender women may rely on sex work, due to the stigma and discrimination from employers in the traditional labor market. Transgender women may also participate in behaviors that can increase the risk of exposure to HIV during sex work, such as unprotected anal sex.
Sexual intercourse without the use of barrier methods can increase the risk of transmitting HIV. A
Research suggests that HIV prevalence is up to nine times higher in transgender sex workers compared with cisgender female sex workers. A small 2021 study also notes that in addition to HIV, there is also a higher prevalence of other sexually transmitted infections (STIs), such as chlamydia and gonorrhea, among transgender women who participate in sex work.
Evidence suggests that the rate of alcohol use and substance use is high among transgender individuals. A
Researchers believe that prolonged discrimination and prejudice experienced by transgender women may lead to health risk behaviors such as substance use.
Transgender women experience high rates of low self-esteem and depression. Low self-esteem and feeling disempowered may mean that transgender women may find it harder to insist on condom use. Transgender women who may want to affirm their gender identity and avoid rejection from sexual partners are also more likely to partake in sex without barrier methods.
This can lead to someone participating in sexual activities that come with a higher risk of HIV infection.
Lack of support
Transgender women are less likely to engage with HIV prevention strategies and adhere to HIV care such as antiretroviral medications.
One reason for this is the lack of support from healthcare professionals as well as a potential lack of knowledge or awareness from healthcare professionals in transgender health.
Some people may wish to undergo gender-affirming surgery, such as bottom surgery or vaginoplasty, to help align more with their gender identity. However, this may increase the risk for HIV as the tissue of the neovagina may be more susceptible to bleeding or infection. Regular use of dilators, condoms, and lubrication may help minimize this risk.
There are approaches that transgender women can use to reduce their risk of acquiring HIV. Some of these methods
- using barrier methods such as condoms during sex
- taking pre-exposure prophylaxis (PrEP) before sex to reduce the risk of contracting HIV
- taking post-exposure prophylaxis
within 72 hoursof a possible exposure to HIV avoiding sharing needlesif using injectable drugs, including estrogen
limitingthe number of sexual partners
Transgender women typically face multiple barriers when seeking medical treatment. These may
- lack of access to healthcare professionals who are knowledgeable on transgender health
- financial insecurity
- discrimination and stigma
- homelessness or housing instability
- denial of treatment due to being transgender
- lack of support from healthcare professionals
- insufficient coverage under health insurance
unmet gender affirmationrequirements such as not being on hormone therapy
- lack of knowledge regarding healthcare and treatment options
- mental health complications due to stigma
Transgender women are generally more likely to experience difficulties in accessing treatment. Transgender women may also delay seeking treatment due to discrimination. A person covered under health insurance can seek HIV testing or treatment from their primary physician. This may be free or at a reduced cost.
If a person does not have insurance, they may still be able to receive testing for HIV and other STIs from a free clinic. Resources are available that may help provide affordable HIV testing and treatment.
If a person does not feel comfortable going to their regular doctor, other organizations, such as Planned Parenthood, offer HIV testing and treatment services.
HIV is a virus that attacks the immune system, which can lead to a person being more susceptible to infections. Without treatment, it can progress to stage 3 HIV, also known as AIDS. Transgender women are at higher risk of acquiring HIV than the general population. Factors for this include stigma, discrimination, and economic instability.
Transgender women may also find it difficult to access treatment. Barriers to treatment, due to health inequities, can delay them from receiving the care they require and increase the risk of health complications. Transgender women can use prevention methods to try and reduce their risk of contracting HIV. This may include using condoms and medication that reduces the risk of acquiring HIV such as PrEP.