A new analysis adds to the evidence that transgender women in the United States have higher HIV rates than the general population. The nationwide cohort study revealed racial disparities in HIV diagnoses and identified health inequities that put trans women at risk.

 

In 2019, the Centers for Disease Control and Prevention reported that 2% of new HIV diagnoses were among transgender people. Of the 671 trans people diagnosed that year, 625 were trans women; nearly half were Black and a third were Latina. But more recent data are limited, and research has been curtailed.

 

Sari Reisner, ScD, of the University of Michigan Ann Arbor, and colleagues looked at HIV rates among trans women in the United States and Puerto Rico. They enrolled 2,504 participants between March 2023 and December 2024 and followed them for two years. HIV status was determined at baseline and rechecked semiannually.

 

Nearly one in five were ages 18 to 24. Most (78%) were white, 12% were Black, 5% were Asian and 16% were Latina. A third reported living in poverty, 10% reported sex work, 9% reported recently being unhoused and nearly half relied on public insurance, such as Medicaid, or were un-insured; 16% were considered eligible for pre-exposure prophylaxis (PrEP), and 18% had used PrEP in the past six months, mostly daily pills.

 

In total, 39 trans women were diagnosed with HIV, including 25 who tested positive for the first time at the start of the study and 14 who acquired HIV during follow-up. The overall incidence rate was 3.95 cases per 1,000 person-years, but Black trans women had a 7.4-fold higher risk than white women. HIV incidence was shaped by structural vulnerabilities, including poverty, unstable housing, sex work and lack of insurance.

 

Targeted services for gender-diverse people have helped close such gaps, but recent political shifts put this progress in jeopardy. The Trump administration’s focus on eliminating so-called gender ideology has led to changes in how trans people are counted, removal of data by federal health agencies and cuts to research and services for this population.

 

“Trans women need tailored interventions that are gender-affirming, that are safe, particularly in the current moment in time,” and “continued gender-inclusive research is vital,” says Reisner.