Studies show that transgender women, especially transgender women of color, are disproportionately affected by HIV, but research regarding their HIV risk factors is lacking. To shed light on what’s causing the higher rate of HIV diagnoses, the Centers for Disease Control and Prevention (CDC) developed the National HIV Behavioral Surveillance Among Transgender Women (NHBS-Trans) and published findings in the Morbidity and Mortality Weekly Report and in a special report highlighting the main findings. The data were then further broken down and published in six individual reports.

The main goal of the project was to “conduct an HIV-related bio-behavioral survey to monitor behavioral risks, prevention use and HIV prevalence,” according to the special report. Its main findings were that “transgender women need to be a priority population” and that “HIV prevalence was high [and the] result of complex layering of syndemics [and] social and economic factors.”

In short, the researchers underscored that HIV risk among trans women was related to discrimination, violence, homelessness and low uptake of pre-exposure prophylaxis, or PrEP, to prevent HIV.

For the report, about 1,600 U.S. transgender women from seven project areas—Atlanta, Los Angeles, New Orleans, New York City, Philadelphia, San Francisco and Seattle responded to the survey. In total, 42% tested positive for HIV; when broken down by race/ethnicity this meant that 62% of Black trans women participants, 35% of Latina trans women and 17% of white trans women tested positive for the virus. Other top-line findings include:

  • 63% of participants were living at or below the federal poverty level.
  • 42% experienced homelessness in the past 12 months.
  • 34% exchanged sex for money or drugs in the past 12 months.
  • 23% reported no anal sex in the past 12 months.
  • 86% reported no vaginal sex in the past 12 months.
  • 32% of HIV-negative participants were using PrEP.
  • 92% of HIV-negative participants were aware of PrEP.
  • 90% were currently taking antiretrovirals.
  • 72% were taking hormones for gender affirmation.
  • 20% wanted to take hormones for gender affirmation but were not currently taking them.
  • 54% were verbally abused or harassed.
  • 27% were physically abused or harassed.
  • 22% of HIV-negative participants had seriously thought about suicide.
  • 12% of HIV-positive participants had seriously thought about suicide.

To address these disparities and improve quality of life for transgender women, the CDC authors emphasize the need for better housing services, behavioral health services, employment, gender-affirming care and clinical care.

“Findings from NHBS-Trans can help guide community leaders, clinicians, and public health officials in improving access to and use of HIV prevention and treatment services by transgender women,” the authors wrote.

Below are the links to the six individual reports according to the topics: