Barriers to HIV Treatment and Preventive Care Among Transgender Women

Transgender women experiencing homelessness, poverty, and a lack of a usual source of health care were less likely to receive HIV treatment or preventive care, but use of pre-exposure prophylaxis (PrEP) was common among those who reported severe food insecurity. These findings were published in Morbidity and Mortality Weekly Report.

Researchers evaluated data from 1608 transgender women in 7 urban areas who participated in the National HIV Behavioral Surveillance (NHBS) program from June 2019 to February 2020. The researchers aimed to factors associated with the disproportionate lack of preventive HIV care among transgender women. Poisson regression was used to adjust for patient age, race, ethnicity, and geographic location.

A total of 1608 transgender women participated in the survey, of whom 38% previously tested positive for HIV infection. Of the participants, 78.7% were aged between 18 and 49 years and 21.3% were 50 or older, 35.4% were Black, and 83.2% had active health insurance. In addition, 31.3% of the participants resided in Los Angeles.

Of participants with a previous HIV diagnosis, virologic suppression was less likely among those who experienced homelessness within the past year (adjusted prevalence ratio [aPR], 0.88; P =.003), with the likelihood of virologic suppression decreasing as the number of homeless nights increased.

In contrast, participants with HIV infection who were virologically suppressed were less likely to report severe food insecurity (aPR, 0.84; P <.001) or a lack of adequate health care (aPR, 0.89; P =.027). In addition, these participants were more likely to report comfort with their health care provider (HCP; aPR, 1.17; P =.007).

Participants who tested negative for HIV infection and had received HIV testing within the past year were more likely to report a usual source of health care (aPR, 1.16; P <.001) and comfort with a HCP (aPR, 1.12; P =.004). Use of HIV PrEP was more commonly reported among participants with health insurance (aPR, 1.54; P <.001), a usual source of health care (aPR =2.54; P <.001), and those who reported comfort with their HCP (aPR, 1.79; P <.001). Of note, use of HIV PrEP also was more common among participants who reported severe food insecurity (aPR, 1.23; P =.024)

Study limitations included the lack of generalizability outside of urban areas, potential recall and social desirability bias due to the self-reported method of data collection, the inability to infer causality, and the lack of representation owing to the complexity of gender-affirming health care.

“Ensuring access to gender-affirming health care approaches and addressing the socioeconomic challenges of many transgender women could improve access to and use of HIV prevention and care in this population,” the researchers concluded.

Disclosure: One author declared affiliations with industry. Please see the reference for a full list of disclosures.


Lee K, Trujillo L, Olansky E, et al. Factors associated with use of HIV prevention and health care among transgender women – Seven urban areas, 2019-2020. MMWR Morb Mortal Wkly Rep. 2022;71(20):673-679. doi:10.15585/mmwr.mm7120a1