HIV/AIDS and Transgender Persons

What We Know

Although limited inofmation is available about HIV/AIDS among transgender persons, HIV infection may be high among this population.

• A Centers for Disease Control and Prevention (CDC) review of an outbreak of tuberculosis among a group of 26 transgender persons in Baltimore found that 62% were HIV infected.(1)
• Estimated HIV infection rates among specific transgender populations range from 14%-69% acccording to several transgender HIV/AIDS needs assesments and sexual risk behavior studies. The highest prevalence may be among male-to-female (MTF) transgender sex workers(2)
• Risky behaviors may be high among transgender persons, according to multiple transgender HIV/AIDS needs assessments. Risk factors include: multiple sexual partners, irregular condom use, unsafe injection practices (drugs and other substances including hormone and silicone injections); as well as lack of transgender-appropriate education and prevention activities. (2)
• Although HIV/AIDS risk behaviors may be reportedly high among transgender persons, many transgender persons self-identify as having low risk (according to various local HIV/AIDS needs assessments of non-infected individuals and those not previously tested for HIV).(2)
• Transgender people face stigma and discrimination, which exacerbates their HIV risk. The stigma of transgender status is associated with lower self-esteem, increased likelihood for substance abuse and survival sex work in MTF's, and lessened likelihood of safer sex practices. Social marginalization can result in the denial of education, employmen and housing opportunities (1-3)
• Ther are few transgender-sensitive HIV/AIDS prevention activities. In addition, access to care for HIV disease may be limited due to low socio-economic status, lack of insurance, fear of one's transgender status being revealed, provider lack of knowledge about caring for transgender persons, and provider discrimination (e.g., exclusion services such as drug rehabilitation programs, verbal harassment and mistreatment).(1-3)
• In a study of persons diagnosed with AIDS between 1990-2000, and reported to CDC from 3-4 states, transgender persons were more likely to be Black, Hispanic, or Asian Americans/Pacific Islanders, compared to other persons with AIDS.

What We Can Do

• Data. Improve data collection on transgender persons and HIV infection, particularly, separation of transgender people from the men-who-have-sex-with-men (MSM) category in data reporting. This can take place in partnerships between CDC, other researchers, and transgender communities.
• HIV/AIDS Prevention. HIV/AIDS is not always a priority issue in the transgender community because so many other basic survival issues outweigh it. In order to effectively reach this community, HIV/AIDS prevention and care programs might be incorporated into a broader outreach effort, such as job training or general acccess to health care.
• Education of Decision-Makers. Conduct outreach to educate policymakers, health providers, and others about transgender people and their concerns.
• Providers. Build provider competency to address transgender health and its relationship to HIV/AIDS transmission and prevention.

Defining Transgender Individuals whose gender identity, expression, or behavior is not traditionally associated with their birth sex. Some transgender individuals experience gender identity as incongruent with their anatomical sex and may seek some degree of sex reassignment surgery, take hormones, or undergo other cosmeetic procedures. Others may pursue gnder expression (masculine or feminine) through external self-presentation and behavior. There are no reliable data on the number of transgender individuals in the U.S. (4)

Resources

• Asian Pacific AIDS Intervention Team, 605 West Olympic BLVD., #610 Los Angeles, CA 90015, 213-553-1845
  www.members.labridge.com/lacn/apait
• Gender Education & Advocacy, P.O. Box 65, Kensington, MD 20895, 301-949-3822, voice mailbox #8
  http://www.gender.org/
• International Journal of Transgenderism www.symposion.com/ijt
• LLEGO (National Latina/o Lesbian, Gay Bisexual & Transgender Organization), 1612 K Street, NW Suite 500, Washington, DC 20006, 202-466-8240
  http://www.llego.org/
• Positive Health Project, 301 West 37th Street, 2nd Floor, New York, NY 10018, 212-465-8304
  http://www.positivehealthproject.org/
• Proyecto ContraSIDA Por VIDA, 2973 16th Street, San Francisco, CA 94103, 415-864-7278
  http://www.pcpv.org/
• Safe Haven Outreach Ministry, 805 Florida Avenue NW, Washington, DC 20001, 202-299-0701
• TGNet Arizona, 2818 North Campbell, PMB 315, Tucson, AZ 85719, 520-742-5686
  tgnetarizona.org
• TransHealth and HIV Education Development Program, 132 Boylston Street, 3rd Floor, Boston, MA 02116, 617-457-8150 ext. 342
  http://www.jri.org/