Risk of HIV/AIDS Among Transgender Individuals Remains High, as Testing Rates Are Still Low: Public Health Watch

Upon taking office in March, new US Centers for Disease Control and Prevention (CDC) director Robert Redfield, MD, set an ambitious goal for the agency’s staff, and health care professionals nationwide: ending the HIV/AIDS epidemic in the nation “in the next 3 to 7 years.”

In his remarks, as reported by The Hill on March 30th, Dr. Rosenfeld cited the advances made in therapeutics, including HIV prophylaxis, and the resources now widely available to at-risk populations, including condoms and screening programs. However, advocates within the HIV/AIDS arena note that significant challenges remain.

Among them: Addressing the incidence of the disease among transgender populations and encouraging those who identify as transgender to get tested.

Since 2016, the US public health community has observed National Transgender HIV Testing Day each April 18th. In announcing its efforts in connection with the event, in an email sent out last week, the CDC shared some troubling statistics: according to the agency, 22% to 28% of transgender women are living with HIV, as are an estimated 56% of black/African-American transgender women. A paper published in 2016 suggests that as many as 1 million Americans currently identify as transgender.

“[National Transgender HIV Testing Day] is an opportunity for transgender people to get tested for HIV and know their status, and to promote HIV prevention and treatment efforts,” the agency said in its email last week. “HIV testing is the first step for people living with HIV to begin treatment, which can keep them healthy. The sooner people living with HIV learn their status and start treatment, the more they benefit. Treatment can also help prevent transmission to others: people living with HIV who take their HIV medicine as prescribed and achieve and maintain viral suppression have effectively no risk of transmitting HIV to HIV-negative sexual partners.”

In all, nearly 40,000 new cases of HIV/AIDS are diagnosed annually in the United States, the CDC reports. Although cases among transgender individuals are relatively rare—with a little more than 2300 documented diagnoses between 2009 and 2014, according to the agency—they may also be under-reported because of what officials describe as the “challenges in accurately identifying and reporting gender identity in HIV surveillance.” Indeed, data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate two-thirds of transgender men and women have not been tested for HIV/AIDS. The UK-based education and advocacy organization Avert says that “stigma and discrimination” remain significant barriers preventing those at risk from being tested for HIV/AIDS, which renders “HIV epidemic… heavily concentrated among certain… key population groups” such as those who identify as transgender.

In conjunction with this year’s National Transgender HIV Testing Day, the CDC has implemented several initiatives in order to improve testing rates among transgender Americans, including providing additional funding to community-based organizations offering testing programs as well as bolstering Project PrIDE, which supports health departments’ efforts to provide PrEP to transgender women. The agency will also be offering new continuing medical education programs designed to assist healthcare providers in delivering patient-centered HIV prevention and care to transgender individuals.

“Culturally appropriate, focused HIV testing efforts are needed to increase testing in transgender communities,” the agency stated. “CDC is working with partners to expand the reach of HIV testing, prevention, and treatment services for transgender people and to address the cultural and socioeconomic factors that place many at increased risk for HIV. Stigma and discrimination, lack of adequate employment or housing, and lack of understanding in health care systems about the needs of transgender people, for example, may keep many from accessing HIV services that could protect them and their partners. Removing these barriers is crucial to making progress toward ending new HIV infections among transgender people.”

A noble objective, and one that should be top of mind every day of the year. Whether it will be enough to help achieve Dr. Rosenfeld’s stated goal remains to be seen.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.