This week, as National LGBT Health Awareness Week comes to a close, we wanted to recognize the ongoing work and challenges to improve the lives of transgender Americans. In February, we held the first-ever White House consultation on HIV among transgender people. The consultation brought community leaders, researchers, and advocates from across the country together with Federal agency partners to discuss issues transgender people face, and what the Federal government can do to reduce their risk of acquiring HIV, support them in accessing HIV care, and improve their lives.
Recognizing that transgender women are among the groups at highest risk for HIV infection in the U.S., when we released the updated National HIV/AIDS Strategy last summer, we committed to developing an indicator on HIV among transgender persons. As we undertake the process of developing this new indicator, we’re doing a robust review of the literature, and considering the science, expert advice, and stakeholder input to identify the best way to measure and monitor HIV in transgender people. This is critical because if we can’t measure something, we can’t understand where to target our efforts and which are most effective. The consultation last month was part of our ongoing effort to inform the development of the transgender indicator and to involve key stakeholders and leaders in the development process.
At the consultation, we heard about what data we do and do not have on the transgender community at the Federal level. In the Ryan White HIV/AIDS Program, for example, Dr. Laura Cheever of HRSA highlighted that data on transgender clients is collected and analyzed each year. However, the data show that despite high overall rates of retention in care and viral suppression (80% and 81% of clients, respectively) in the program, transgender clients are experience slightly lower rates (78% and 74%, respectively).
In addition, Dr. Eugene McCray from CDC noted that overall, we have limited HIV surveillance data on how many transgender people in the United States are living with HIV because data for this population are not consistently collected. However, data collected by some local health departments and scientists studying these communities show high HIV prevalence and racial/ethnic disparities among transgender populations. Data suggest that around 28% of transgender women are living with HIV and that African American transgender women have higher rates than other groups of transgender women. This high HIV prevalence is one of the reasons we identified transgender women in the updated Strategy as a population on which we need to focus our efforts.
We know that this community experiences a spectrum of issues that exacerbate the risk for HIV acquisition and transmission, and many transgender participants at the consultation bravely shared their stories. Intense social stigma and discrimination often affect access to housing, jobs, and education, and can lead to violence and trauma. Many reported limited health care access and a lack of culturally competent health care services, and, in some cases, pursuit of high-risk behaviors, including sex work, to meet basic survival needs.
To address the disparities that exist, the Administration has taken tremendous steps in reducing the inequities transgender people face. This has included the signing of an executive order to prohibit Federal contractors and subcontractors from discriminating on the basis of sexual orientation or gender identity, and the hosting of an LGBTQ Tech & Innovation Summit, which created #TransNeeds, a national online “listening campaign” to identify the needs of transgender Americans.
Ongoing anti-discrimination, research, data collection, training and outreach efforts are also taking place across the Federal government. HHS overall has made strides in including gender identity and sexual orientation on several national surveys. The Department of Defense has started looking at the policy and readiness implications of welcoming transgender people to serve openly in the military. Other agencies have held trainings on gender identity awareness and hate crime prevention.
From the ONAP consultation, it was clear to us that more work must be done to improve HIV outcomes among transgender people, but that the issue is much more complex than one disease and one population. It’s layered with issues of stigma, discrimination, the struggle to meet basic needs, and imperfect data, to name a few. We need a wider network of culturally competent providers, increased capacity building and technical support for transgender-focused organizations at the local level, and improved data collection. During the consultation, we kept thinking about a recurring theme around the White House: we are our brothers and sisters’ keepers. Thus, we look forward to further efforts address HIV and how we can all work together to improve outcomes among our transgender brothers and sisters.
To learn more, see the CDC fact sheet, HIV Among Transgender People.
Amy Lansky, PhD, MPH is Acting Director of the Office of National AIDS Policy.
Raffi Freedman-Gurspan is Outreach & Recruitment Director for Presidential Personnel and Associate Director for Public Engagement at The White House.