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.

Evidence from the Centers for Disease Control and Prevention (CDC) highlights that transgender women are at a particularly high risk for HIV infection and HIV is prevalent in this population.

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.

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According to the CDC, approximately 1 million people in the United States identify as transgender and 2% of new HIV diagnoses in the U.S. in 2018 were among transgender people. The Human Rights Campaign adds that 21.6% of transgender women in the U.S. are living with HIV.

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, 42% had HIV. By race and ethnicity the prevalence was:

  • 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 include:


Transgender women disproportionately experience societal stigma and bias compared with their cisgender peers. This can also include health insurance policies that are not transgender-inclusive, which can prevent transgender women from seeking adequate medical care.

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 increase the risk of HIV transmission. A 2015 study found that ethnic minority transgender women were more likely to experience racial discrimination compared with white transgender women.

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.

Economic vulnerability

Issues related to an individual’s economic standing, such as access to healthcare, employment, and housing, can increase the risk of HIV in transgender women.

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.

Sex work

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 2015 study found that ethnic minority transgender women were more likely to engage in anal sex without condoms, compared with white transgender women.

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.

Drug use

Evidence suggests that the rate of alcohol use and substance use is high among transgender individuals. A 2015 study also notes that substance use was prevalent among young transgender women. This includes injection drug use, which is associated with a higher risk of HIV.

Researchers believe that prolonged discrimination and prejudice experienced by transgender women may lead to health risk behaviors such as substance use.

Low self-esteem

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.

Gender-affirming surgery

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 include:

Transgender women typically face multiple barriers when seeking medical treatment. These may include:

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.

There is currently no effective cure for HIV. However, medication such as antiretroviral therapy is available to treat HIV and allow people with HIV to live long and healthy lives.

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.