Health Care Use and HIV-Related Behaviors of Black and Latina Transgender Women in 3 US Metropolitan Areas: Results From the Transgender HIV Behavioral Survey

Abstract

Purpose HIV prevalence estimates among transgender women in the United States are high, particularly among racial/ethnic minorities. Despite increased HIV risk and evidence of racial disparities in HIV prevalence among transgender women, few data are available to inform HIV prevention efforts. Methods A transgender HIV-related behavioral survey conducted in 2009 in 3 US metropolitan areas (Chicago, Houston, and Los Angeles County), used respondent-driven sampling to recruit 227 black (n = 139) and Latina (n = 88) transgender women. We present descriptive statistics on sociodemographic, health care, and HIV-risk behaviors. Results Of 227 transgender women enrolled, most were economically and socially disadvantaged: 73% had an annual income of less than $15,000; 62% lacked health insurance; 61% were unemployed; and 46% reported being homeless in the past 12 months. Most (80%) had visited a health care provider and over half (58%) had tested for HIV in the past 12 months. Twenty-nine percent of those who reported having an HIV test in the past 24 months self-reported being HIV positive. Most of the sample reported hormone use (67%) in the past 12 months and most hormone use was under clinical supervision (70%). Forty-nine percent reported condomless anal sex in the past 12 months and 16% reported ever injecting drugs. Conclusion These findings reveal the socioeconomic challenges and behavioral risks often associated with high HIV risk reported by black and Latina transgender women. Despite low health insurance coverage, the results suggest opportunities to engage transgender women in HIV prevention and care given their high reported frequency of accessing health care providers.

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

“…Lack of use of hormones was also associated with a severalfold increased odds of HIV infection. Under half of transgender women in our survey had ever taken hormones and fewer than one in five had ever had gender-affirming surgery, figures that are quite low compared with those of other countries [3, 9,26]. At least one study in China documented a large unmet need and desire for gender transition care, including 90% demand for hormones and 50% demand for gender-affirming surgery [27].…”

Sexual Behaviors, Referral to Sexual Health Services, and Use of Sexual Health Services Among Transgender High School Students

“…These sexual behaviors may contribute to the high prevalence of HIV and STDs among transgender adolescents. Additionally, behaviors developed during adolescence may contribute to the high prevalence of HIV and STDs in young adult transgender populations . These findings highlight the need for effective interventions to help promote protective behaviors such as condom use among transgender adolescents.…”

“…Racial and ethnic minority transgender adults may disproportionately be affected. For example, one study found as many as 29% of Black and Latina transgender women self‐reported being HIV positive in 3 US metropolitan areas . Less is known about HIV prevalence among gender non‐binary adults; however, one study suggests they may have an HIV prevalence equal to or greater than those who identify as transgender men or transgender women .…”

Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women

“…In California, transgender female clients of publicly-funded counseling and testing sites have higher rates of HIV diagnosis (6%) than all other risk categories, including MSM (4%) and partners of people living with HIV (5%), and African American transgender women have a particularly high rate of HIV diagnosis (29%) (10). Estimates from other urban centers in the US similarly suggest that HIV prevalence rates among transgender women are among the highest of all key populations, especially for transgender women of color, and African American transgender women are most severely impacted (8,11,12).…”