Some countries criminalise transgender people or people who ‘impersonate’ the other gender such as by cross-dressing. Some countries also criminalise same-sex sexual activity. A transgender person could break two laws if they have sex with someone of the same sex as their sex assigned at birth. This makes them too afraid to use HIV services for fear of being arrested.
HIV and transgender people
- Transgender women are 34 times more likely to have HIV than other adults.
- Of all new HIV infections in 2020, 2% were among transgender people.
- In some places, up to 40% of transgender women have HIV.
Transgender and gender diverse people have a different gender identity to the one they were assigned at birth. A transgender woman is a woman who was assigned male at birth. A transgender man is a man who was assigned female at birth. Some people identify as non-binary, which means they don’t identify as male or female. There are many other words to describe transgender people, including hijras or third gender.
Lots of transgender people experience stigma, discrimination and transphobia. This is when someone experiences prejudice because of their gender identity.
This leads to all sorts of barriers to accessing HIV services. Transgender women are most at risk of HIV, but transgender men also have an elevated risk of HIV compared to the general population.
Why are transgender people at higher risk of HIV?
Being transgender is a crime in some countries
Transphobia, stigma, discrimination and negative attitudes are common
This stops transgender people from wanting to access HIV and other health services, get an education (including on sexual health), or report crimes to the police. It also increases high-risk behaviour such as sex without a condom or injecting drugs.
There is a higher risk of violence
Violence towards transgender people is widespread and has been increasingly reported. It is particularly common from intimate partners which can include rape or sex without a condom.
They are more likely to be kicked out of home or be homeless
Transgender people are often rejected by their family and forced onto the street. Having no fixed address makes it harder to access services, adhere to treatment, and risks poor physical and mental health.
Some transgender people sell sex
Because transgender people are often socially excluded it can be hard to find a job. Many sell sex to make a living, which increases their risk of HIV due to violence and inconsistent condom use.
Injecting hormones with shared needles
Some transgender people inject hormones. If these needles are shared with others, there is a risk of HIV transmission.
Prevention services don’t meet their needs
HIV services often assume transgender people are men who have sex with men, and don’t have services that cater for the needs of transgender people as a separate group.
How can HIV services meet the needs of transgender people?
Involve transgender people
Involve transgender people in the design and delivery of HIV services. This way the service is more likely to meet their needs.
Remove negative attitudes
Provide education and sensitisation training for healthcare staff to reduce negative attitudes towards transgender people, so that they are more likely to come back again, test for HIV and access treatment.
Provide PrEP and PEP
HIV could be avoided if transgender people could access PrEP (pre-exposure prophylaxis) before exposure to HIV, or PEP (post-exposure prophylaxis) after exposure to HIV.
Make condoms available
Because of the fear of attending a health service, it is important to make condoms available to transgender people at other places they might meet up at or via peer educators in the community.
Collect data on transgender people
Collect and record data on transgender people as a separate group from men who have sex with men, or their assigned at birth identity. This will help to build up a better picture of their needs and HIV risk.
What systemic changes could reduce the risk of HIV for transgender people?
Remove laws that criminalise transgender people
Transgender people would be more likely to access HIV and police services if there wasn’t a constant threat of being criminalised. This would also protect transgender people from violence and abuse.
Allow change of gender on identity documents
If people could change their gender identity on official documents, they would feel more comfortable accessing services that require ID, such as health services and law enforcement.
Stop police harassment
Law enforcement officers need to be educated and sensitised about the rights of transgender people. By respecting their rights, police officers could help rather than punish transgender people.
End stigma and discrimination
Education is needed to change harmful societal attitudes and norms about gender. Ending stigma would help reduce transgender people’s risk of HIV.
Make violence against transgender people illegal
No-one should experience violence because of their gender identity. Laws that protect transgender people from violence would enable them to access HIV, health and police services.