Recent data on the high burden of HIV among transgender women have stimulated interest in addressing HIV in this vulnerable population. This review situates the epidemiologic data on HIV among transgender women in the context of the social determinants of health and describes opportunities for effective interventions.
Transgender women experience unique vulnerability to HIV that can be attributed to multilevel, intersecting factors that also influence the HIV treatment and care continuum. Stigma and discrimination, lack of social and legal recognition of their affirmed gender, and exclusion from employment and educational opportunities represent fundamental drivers of HIV risk in transgender women worldwide.
Interventions to improve engagement in HIV prevention, testing, care, and treatment among transgender women should build on community strengths and address structural factors as well as psychosocial and biologic factors that increase HIV vulnerability and prevent access to HIV services.
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
bThe Fenway Institute, Fenway Health
cDepartment of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
dCallen-Lorde Community Health Center, New York, New York, USA
Correspondence to Johns Hopkins School of Public Health, 615N. Wolfe Street, Room E7138, Baltimore, MD 21205, USA. Tel: +1 202 203 7490; e-mail: TPoteat@jhsph.edu