Eliminating the stigma begins with knowing your status.
By Barrett White
On average, the Centers for Disease Control and Prevention estimates there are nearly 40,000 new HIV transmissions every year, with the highest rates found in the South—and of major cities in the South, Houston is a hotbed for new infections.
In the most recent HIV surveillance report from the Texas Department of State Health Services, Harris County has the most new HIV diagnoses statewide during the first six months of 2018. More than 40% of all new diagnoses in Harris County are in the African-American community, according to 2018 data from the Houston Health Department. More than 32,000 people in the county are living with HIV.
For the transgender community, the numbers shake out just about the same: According to the CDC, nearly half of all new HIV infections in the U.S. among transgender individuals are in the South. Further, among the 3 million HIV testing events reported to the CDC in 2017, the percentage of transgender people who received a new HIV diagnosis was three times the national average.
The disproportionate burden of HIV infections among transgender individuals can be attributed to a few factors, the CDC continues:
- Many transgender people face stigma, discrimination, social rejection, and exclusion that prevent them from fully participating in society, including accessing health care, education, employment, and housing, as well as violence and lack of family support. These factors affect the health and well-being of transgender people, placing them at increased risk for HIV. For many transgender individuals, the issues discussed in this bullet point alone may be the catalyst for the roadblocks to care presented in the bullet points below.
- Certain factors include commercial sex work, mental health issues, incarceration, homelessness, unemployment, and high levels of substance use compared to the general population.
- HIV behavioral interventions developed for other at-risk groups have been adapted for use with transgender people. However, the effectiveness of these interventions is understudied.
- Transgender women and men might not be sufficiently reached by current HIV testing measures.
- Transgender men’s sexual health has not been well studied. Transgender men, particularly those who have sex with cisgender (persons whose sex assigned at birth is the same as their gender identity or expression) men, are at high risk for infection.
- Lack of knowledge about transgender issues by health care providers can be a barrier for transgender people who receive an HIV diagnosis and are seeking quality treatment and care services.
- Transgender women and men might not fully engage in medical care. In a study of transgender men with HIV who were receiving medical care, 60% had maintained an undetectable viral load over the previous 12 months. A 2015 study found that 50.8% of transgender women who were receiving medical care had maintained an undetectable viral load over the previous 12 months. Taking HIV medicine as prescribed and keeping an undetectable viral load (or staying virally suppressed) is the best thing people with HIV can do to stay healthy and protect their sexual partners.
- Transgender and other gender minority youth are an at-risk group understudied in HIV prevention (e.g., PrEP) and HIV treatment. But one study of transgender youth found that medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments.
- Transgender-specific data are limited. Some federal, state, and local agencies do not collect or have complete data on transgender individuals. Using the two-step data collection method of asking for sex assigned at birth and current gender identity can help increase the likelihood that transgender people are correctly identified in HIV surveillance programs. Accurate data on transgender status can lead to more effective public health actions.
“Creating spaces where one can be tested without judgement is the first step toward eliminating stigma,” says Dr. Natalie Vanek, infectious diseases physician and HIV expert at Legacy. “Fighting to end the HIV epidemic is where Legacy planted our roots. We proudly offer testing at Legacy for anyone and everyone, judgement free; always have and always will.”
Throughout the current pandemic, Legacy has kept open the HIV testing and treatment service line for our patients. If you believe that you are at risk, you can still contact Legacy for HIV testing and treatment, despite the pandemic.
Prevention is key. Get tested with Legacy today. It’s free.