HIV is a virus that weakens the immune system and can worsen the effects of other infections and diseases. Without treatment, HIV may progress to stage three, an advanced stage commonly known as AIDS. Transgender people have a higher risk of HIV and may not have access to adequate care.

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), transgender people are among those at high risk for contracting HIV. This is particularly true of transgender women, who make up a disproportionately high percentage of those with HIV in some regions, according to the WHO.

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

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

This article discusses the potential barriers that those in the transgender community may experience when seeking HIV treatment and suggests ways to overcome these obstacles.

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The Department of Health and Human Services estimates that 1.2 million people in the United States are living with HIV.

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

There is a higher incidence of HIV among transgender People of Color, suggesting that intersecting oppressions and socioeconomic factors play a role.

In 2019, the most recent year for available figures, 46% of transgender women testing positive for HIV were Black or African American, while 35% were Hispanic or Latino, and 13% were white. Similarly, 41% of transgender men testing positive for HIV were Black or African American, while 26% were Hispanic or Latino, and 24% were white.

These numbers grow in large metropolitan areas. In a 2021 CDC survey of 1,608 transgender women who underwent testing in seven major cities, 62% of black or African American individuals were positive for HIV, as were 35% of Hispanic or Latinx individuals and 17% of those who were white.

Numerous factors can increase the chances that transgender individuals contract HIV while limiting access to quality treatment and prevention services. These factors may include the below.

Healthcare discrimination

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

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 surveyed did not receive adequate medical care due to discrimination.

The report added 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 challenging for transgender individuals to access quality information about health, HIV prevention, and HIV care. A 2020 survey found that 65% of transgender women are unfamiliar with preexposure prophylaxis (PrEP), the HIV prevention treatment.

Reduced access to testing

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

Transgender people may also face unemployment, housing discrimination, and poverty, making it more difficult for them 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 women may be more likely than other people to use injectable drugs or engage in sex without a barrier method.

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 increase the risk of HIV. Social marginalization, such as pressure from sexual partners, may make it more challenging for some transgender people to use condoms or other barrier methods while having sex.

Injecting hormones

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

Studies show that people receiving gender-affirming hormone therapy can safely take PrEP medications to help prevent HIV and antiretroviral medications to help manage the virus. Experts have not identified any interactions between the different drugs.

The following strategies can help reduce a transgender person’s risk of contracting or spreading HIV:

  • Minimizing and improving the use of injectable drugs: Using injectable drugs, especially those that a doctor has prescribed, increases the risk of exposure to HIV and other blood-borne pathogens. People who take injectable drugs of any type should use a new needle before each injection and never share needles. It is also important to ask a healthcare professional about safe injection practices when taking gender-affirming hormones. Many clinics that offer this type of care can provide on-site hormone injections.
  • Having fewer sexual partners: People who limit their number of sexual partners reduce the risk of spreading HIV.
  • Practicing safer anal sex: Receptive anal sex carries a high risk of HIV transmission. With correct use, condoms effectively reduce the risk of HIV transmission.
  • Using barrier methods during sexual contact: Fear of rejection and impaired judgment due to drug and alcohol use, among other factors, can lead people to engage in sexual contact without condoms or other barrier methods. However, these methods help prevent HIV transmission.
  • Taking preventive medications: Taking PrEP before sexual contact may reduce the risk of contracting HIV.

While there is no cure for HIV, it is treatable. The right treatment can save a person’s life, improve their 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 transgender individuals have reduced access compared with cisgender people.

People with insurance may be able to access free or low cost HIV testing through healthcare professionals as part of their annual physicals. Self-test kits are also easy to order online.

Individuals who do not have insurance and cannot afford testing can contact local free clinics. Some health departments offer free or low cost testing, as does Planned Parenthood. Additionally, provides a list of free testing sites.

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

  • discrimination from medical professionals
  • dealing with medical professionals who are not knowledgeable about transgender health or HIV risks
  • 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 reveals they are transgender or HIV-positive

Learn more about the mental health concerns that transgender and nonbinary people face.

Transgender people have a higher risk of contracting HIV and 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.