Abstract
Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.
Highlights
Providing partner services to index transgender women and transgender women partners requires additional efforts to address the social and structural barriers unique to this population, provide timely prevention services, help reduce human immunodeficiency virus (HIV) transmission, and end the HIV epidemic in the United States
The percentage of transgender women partners notified of their potential HIV exposure (71.2%) was lower than that for all partners combined (77.1%), suggesting that there are missed opportunities to improve health of transgender women and to interrupt onward transmission of HIV
46.5% of transgender women partners were tested for HIV, this represented an improvement compared with the 35.6% ever testing and 10.0% past-year testing among transgender women found in an analysis of 2014–2015 Behavioral Risk Factor Surveillance data from 27 states and Guam [5] and was similar to the percentage of transgender women tested for HIV during the past 12 months (53.5%) through CDCfunded community-based organizations in three cities in 2008 [6]
Summary
Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). CDC analyzed HIV partner services person-level data for transgender women, identified using self-reported sex at birth and current gender identity. Partners with previously diagnosed HIV infection should have evidence of an HIV diagnosis from cross-check with the health department surveillance system, review of laboratory reports, medical records, other available data sources (e.g., partner services database), or patient selfreport. Data on index persons and partners were extracted from index person and partner information–specific databases; index persons could not be directly linked with their named partners The outcomes for this analysis are the percentage of index transgender women interviewed for partner services and the percentage of transgender women partners notified and tested for HIV, and who newly or previously received a diagnosis of infection with HIV.
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