Abstract and Introduction

Abstract

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk.

By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels—socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education.

We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

Introduction

Transgender persons are those whose gender identity does not conform to gender norms and expectations traditionally associated with their sex assigned at birth. Cisgender persons are those whose gender identity conforms to their birth sex. A 2008 synthesis of published US studies reported that HIV rates among Black, White, and Hispanic transgender women (assigned "male" at birth) were 56%, 17%, and 16%, respectively.[1] These figures are higher than or comparable with 2011 HIV rates among Black, White, and Hispanic men who had sex with men (36%, 15%, and 17%, respectively)[2] and Blacks, Whites, and Hispanics in general (42%, 4%, and 12%, respectively).[3] HIV infection rates among transgender men (assigned "female" at birth) have been difficult to determine,[4,5] but estimates range from 0% to 3%.[1] Separate rates for nonbinary transgender persons are not available as data on this subgroup are limited.[6]

The United States' National HIV/AIDS Strategy notes that transgender persons are at high risk for HIV infection and efforts specifically targeting transgender populations have been minimal.[7] Given the complex determinants of HIV infection among transgender persons, preferable prevention strategies likely will be comprehensive—a combination of structural, biomedical, and behavioral interventions with demonstrated efficacy in reducing HIV infection.

We summarize the nature of transgender persons' risks for HIV infection, present the best-evidence prevention that is available and how to apply that prevention in transgender-specific and sensitive ways, and elaborate on immediately available options for a comprehensive HIV prevention approach for transgender people.