The State of HIV in Transgender America: Just How Bad is it?

Transgender and gender non-conforming people have higher risks of contracting HIV than nearly any other group. Trans women of color are particularly vulnerable, with 1 in 2 black trans women and 1 in 5 trans Latinas living with HIV, according to the Transgender Law Center. In a study of 400 participants, TLC's Positively Trans program set out to improve our understanding of people living with HIV in the transgender and non-conforming community. Of the 400 participants, 157 people completed surveys referenced in this slide-show. Respondents's gender break-down is shown above. 

The survey was conducted this past summer and was published in both English and Spanish. The majority of participants were trans women of color, with the largest percentage of respondents identifying as African American (33 percent), followed by white (32 percent) and Latino/Latina (26 percent). 

The Positively Trans survey revealed that many trans people with HIV live below the poverty line. Forty-three percent of respondents reported making less than $12,000 a year (the poverty threshold for a single adult in the U.S. is just under $12,000). Another 42 percent made between $12,000 and $47,000 annually; meaning 85 percent of respondents make below the national median household income of $52,000. 

Despite their low  incomes, many trans people living with HIV have higher educations. The surveyed group was highly educated, with 64 percent reporting at least some post-secondary education and 28 percent reporting a bachelor’s or post-baccalaureate degree. Only 15 percent of those surveyed had less than a high school diploma. 

The survey also showed that transgender and gender non-conforming people with HIV live through-out the country and are not confined to the coasts.Responses came from 35 states and Puerto Rico. While 42 and 29 percent reported living in the South and West, respectively, another 14 and 13 percent hailed from the Northeast and Midwest. Two percent were from outside the continental U.S. (Alaska, Hawaii and Puerto Rico). 

A disproportinate number of trans people with HIV have been imprisoned. Forty-one percent of participants in the Positively Trans survey reported some jail time. This is especially disconcerting, according to the Transgender Law Center, in an age of HIV criminalization.  Because of these issues, it was not a surprise that participants listed legal priorities and HIV-related discrimination as top concerns.

Participants listed various forms of discrimination as their top legal concerns, whether that discrimination was due to their HIV status (69 percent) or gender identity/presentation. Employment (65 percent) and day-to-day discrimination were also major concerns; with 59 percent worried about public accommodations (like restroom use), 59 percent worried about identification documents, and 54 percent concerned with housing discrimination. These concerns are understandable considering the environment in the U.S. where few legal protections currently exist for transgender people. 

The majority of respondents reported being fairly confident that they knew their rights, both as trans people and as people living with HIV. However, about 40 percent still remained unsure. 

Most of those who took the Positively Trans survey characterized their health as “good” and the majority had achieved fully suppressed viral loads. Possibly because of that fact, concern with antiretroviral medication and their side effects was the lowest of their five top health concerns. Gender affirmation and hormone therapy side effects topped the list, with 59 percent of respondents listing gender affirmation and 53 percent picking hormone side effects as their top health concern. Other top issues included mental health and personal care. 

Trans people with HIV often face discrimination when they seek medical care. In response to questions about health care discrimination, 31 percent of survey respondents reported having a doctor refuse them care based on their gender; while 20 percent said they were refused care because they were HIV positive. 

Forty-one percent of transgender people with HIV who responded to the survey reported they have gone more than six months without care since their HIV diagnosis. Studies have shown that getting into care early, and continuing on antiretroviral medications without interuption can have long term health benefits and increase life expectancy.  More work is necessary for all HIV-positive trans people to be connected with and retained  in care. 

It can be difficult for trans people to find competent and trans-friendly health care providers. Only 9 percent of the survey respondents reported having a transgender or gender non-conforming health care provider, while 12 percent reported having trans or gender non-conforming caseworkers. Still, a significant number reported trans and gender non-conforming workers among receptionists (16 percent), other staff (16 percent), and management (12 percent). 

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