Why Transgender Females Most Threatened by HIV | Hartford Hospital

January 03, 2022

The number of HIV infections and deaths has decreased since its peak in the early 1990s, but it remains a threat and, according to recent research, the population most threatened is transgender females.

“AIDS is certainly not all gone. We estimate more than one million people live with it in the United States today,” said Dr. Patrick Cahill, an infectious disease specialist and medical director of HIV primary care at Hartford Hospital’s Community Care Center. “About 10 percent of people with HIV don’t even know they have it.”

Researchers from Maastricht University in the Netherlands recently released their analysis of data from 98 studies in 34 countries between 2000 and 2019. They found HIV infection disproportionately affects transgender people. Transfeminine people are 66 times more likely to test HIV-positive and transmasculine people 6.8 times more likely.

“Marginalization, discrimination and stigma” are the reasons, the researchers noted, which did not surprise Dr. Cahill.

“We’ve known for a while that the transgender community is more at risk of pathologies like HIV,” he said, adding mental health conditions and substance use disorders are also higher for transgender people. “They try to be discrete on many levels, so they often engage in riskier behavior than others. This exposes them to a higher risk population.”

Popular dating apps popular are linked with specific and risky patterns such as drug use and unprotected sex, Dr. Cahill added.

“There are mental health issues that are reflective of the environment, not actual psychological disease,” he said. “People, ashamed or nervous, are forced to go underground to find connections. There are also people who prey on such vulnerable people who are just looking for acceptance.”

The most important thing all sexually active individuals should remember is safe sexual practices and, if necessary, regular testing for HIV and sexually-transmitted diseases. Everyone should be tested at least once in their life, according to screening guidelines. Anyone having unprotected sex or using intravenous drugs should be tested more often, Dr. Cahill said.

Testing doesn’t require a HIV primary care program like his in Hartford, he stressed. People can have honest conversations about their social and sexual history with their primary care provider, who can recommend healthier behaviors like condom use and even prescribe medication to block HIV through sexual transmission, something the Centers for Disease Control and Prevention has said is 99-percent effective.

“There are now options to prevent and treat HIV. It is preventable. We need to identify high risk and engage people in some level of medical care,” Dr. Cahill said.

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