HIV is a virus that alters the immune system and can increase the impact of other infections and diseases. Without treatment, HIV may progress to stage 3, an advanced stage commonly known as AIDS. Transgender people are at a higher risk of HIV and may not have access to adequate care.

According to both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), transgender people have a higher risk of HIV than other people. Evidence suggests that this is particularly true for transgender women.

Simple interventions can greatly reduce the spread of HIV, and treatment can save lives. However, due to the health inequities that transgender people often experience, they may not receive the help they require.

A range of factors, such as violence, legal barriers, stigma, and discrimination, may affect the access that transgender people have to healthcare and HIV services.

In this article, we discuss the potential barriers that transgender people may experience when seeking HIV treatment and suggest possible ways to overcome these obstacles.

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The Department of Health and Human Services (HHS) estimate that 1.2 million people in the United States currently have HIV.

Data from the CDC show that nearly 1 million people in the U.S. identify as transgender. Of these individuals, 9.2% have HIV, with the virus affecting 14.1% of transgender women and 3.2% of transgender men. By comparison, the estimated HIV prevalence for U.S. adults overall is less than 0.5%.

The HHS note that transgender People of Color, especially Black people, face disproportionately high rates of HIV, suggesting that intersecting oppressions and socioeconomic factors may play a significant role. In the U.S., in 2018, Black people accounted for 45.4% of new HIV diagnoses.

According to the CDC, HIV prevalence is highest among Black transgender women, with 44.2% having received a diagnosis. In comparison, 25.8% of Latinx transgender women and 6.7% of white transgender women are living with HIV.

Numerous factors can conspire to both increase the odds of HIV among transgender individuals and decrease access to quality treatment and prevention. These factors may include:

Health discrimination

Transgender people face high rates of health discrimination. This discrimination may take the form of doctors not knowing how to care for transgender people or deriding or abusing them, such as by refusing to use their correct names or pronouns. Some doctors may even try to avoid treating transgender people.

A report from the National Gay and Lesbian Task Force and the National Center for Transgender Equality found that nearly 1 in 5 transgender individuals did not receive care due to discrimination.

The report adds that 28% of survey respondents reported postponing medical care due to discrimination, with the same percentage of respondents reporting exposure to harassment in medical settings.

Lack of access to health information

Health discrimination may also make it more difficult to access quality information about health, HIV prevention, and HIV care. A 2020 survey found that the majority (65%) of transgender women are unfamiliar with pre-exposure prophylaxis (PrEP), the HIV prevention treatment.

Low access to testing

Transgender individuals may struggle to access HIV testing, so they might not know that they have HIV. As a result, they might not take steps to prevent the virus from spreading to others.

Transgender people may also face unemployment, housing discrimination, and poverty, making it more difficult to find and pay for testing and care.

High risk behavior

Transgender individuals may be more likely to engage in behaviors that increase the chances of HIV spreading. For example, data suggest that transgender people may be more likely than other people to use injectable drugs or have unprotected sex.

Sociological factors, such as discrimination, play a significant role in this risk-taking. Stigma, social ostracism, and economic vulnerability may lead to drug use, sex work, and other behaviors that may elevate the risk of HIV. Low self-esteem and marginalization can make transgender women more likely to have sex without using condoms or other barrier methods.

Injecting hormones

Many transgender people may use hormones as part of gender-affirming therapy, which may involve the use of injectable hormones. However, without counseling on safe injecting practices, people may be vulnerable to HIV transmission due to the risk of sharing needles or using unclean needles.

Research also indicates that some forms of estrogen may interact with antiretroviral therapy (ART), which may cause some people to prioritize hormone therapy over HIV treatment. Additionally, progesterone may increase HIV susceptibility in some individuals, although more research is necessary to confirm this association.

The following strategies can help reduce a person’s risk of contracting HIV and prevent the virus from spreading:

  • Avoiding using injectable drugs: It is best to avoid using these drugs completely. However, if people do use injectable drugs, they should use a new needle before each injection and never share needles. If possible, people may wish to consider receiving hormone injections at a medical center or undergoing training to avoid unsafe injection practices.
  • Minimizing the number of sexual partners: Limiting the number of sexual partners will reduce the risk of HIV spreading.
  • Being aware of the risks of anal sex: Anal sex carries a high risk of HIV transmission, and the rate of unprotected anal sex among transgender women is high. As hormone therapy can lead to erectile problems, transgender people may be more likely to take the receptive role during sex.
  • Using barrier methods during sexual contact: Various factors, including a fear of rejection and impaired judgment due to drug and alcohol use, can lead people to agree to sex without a condom. However, condom use can help prevent the transmission of HIV.
  • Medications: Taking PrEP before sexual contact may reduce a person’s risk of contracting HIV.

While there is no cure for HIV, it is treatable. The right treatment can save a person’s life, improve quality of life, and even reduce the risk of the virus spreading to others. People should consider testing at regular intervals, especially if they suspect that they have had exposure to the virus.

While data on transgender access to HIV treatment and testing services are scarce, most information suggests that these individuals have reduced access compared with cisgender people.

People with insurance may be able to access free or low cost HIV testing through a primary care provider as part of their annual physical.

People who do not have insurance or a doctor and cannot afford testing can contact a local free clinic. Some health departments offer free or low cost testing, as does Planned Parenthood. HIV.gov provide a list of free testing sites.

Additionally, the CDC are funding Project PrIDE. This project aims to support health departments in implementing public health strategies to reduce new HIV infections, increase access to care, improve health outcomes for those living with HIV, and reduce HIV-related disparities and health inequities.

Transgender people face numerous barriers that can stop them from receiving the care they require. These barriers can include:

  • discrimination and stigma from medical professionals
  • medical professionals who are not knowledgeable about transgender health or HIV risk
  • difficulty paying for care or finding low cost care
  • shame or embarrassment about transgender identity
  • unemployment and homelessness
  • mental health issues, including those stemming from discrimination and exclusion
  • discrimination in insurance coverage or healthcare
  • fear of violence if a person were to tell others that they are transgender or HIV-positive

Learn more about the mental health concerns that transgender men face.

Transgender people have a higher risk of HIV, and they may face barriers in receiving treatment due to health inequities. Removing these barriers and making interventions and treatments more accessible can greatly reduce the risk of HIV spreading and save lives.