New research published this week by the Centers for Disease Control and Prevention (CDC) suggests that social and economic marginalization, including employment and housing discrimination, increases transgender women’s risk of contracting HIV.
The report, published Thursday in the CDC’s Morbidity and Mortality Weekly Report, analyzed data from a survey of more than 1,600 transgender women in seven U.S. cities from 2019 to 2020. The goal of the survey was to assess for the first time the factors that have led transgender women—and especially trans women of color—in the U.S. to have disproportionately high rates of HIV infection.
Survey participants were also provided with HIV testing, with 42 percent of participants testing positive for HIV. Among Black participants, 62 percent were HIV positive compared to 35 percent of Hispanic and Latina participants and 17 percent of white participants.
Overall, nearly 70 percent of participants reported experiencing at least one type of anti-trans discrimination in the past 12 months. Over 32 percent said they’d had trouble finding a job, while nearly 10 percent said they had been fired. Nearly 14 percent said they were denied housing or evicted because they were transgender.
The analysis showed that employment discrimination is particularly impactful on health outcomes for trans women, as employment and health insurance coverage are “intertwined in the United States.”
“When economically marginalized transgender women are refused employment,” researchers wrote, “this refusal cyclically contributes to economic hardships and might lead them to engage in survival sex work and potentially incarceration,” factors that are also related to increased risk of contracting HIV.
Similarly, nearly a third of participants reported experiencing periods of homelessness and housing instability, which are also associated with an increased risk of HIV infection.
Researchers also found that the more psychological and structural stressorstransgender women face, the more likely they are to engage in sexual behaviors that put them at risk of HIV infection.
CDC researchers urged policymakers to use the results of their analysis to guide civil rights legislation efforts and to tailor HIV prevention and housing services for transgender women.
“It is no secret that trans people, trans women, and especially trans women of color face immense barriers in HIV prevention,” New York University professor and queer health advocate Joseph Osmundson, who was not involved in the CDC research, told STAT News. “This new research not only formalizes this knowledge but addresses some of the underlying reasons, including increased rates of homelessness and transactional sex.”
“Policies that reduce poverty, increase access to healthcare, and address homelessness for all can have an outsized effect for trans women, and including trans people as leaders of these efforts will be necessary to their success,” Osmundson said.