Understanding sexual behavior in transwomen

Understanding sexual behavior in transwomen
May 27, 2021
Groundbreaking study looks at HIV infection, risk, prevention, and testing behaviors among transgender women 
For more than 20 years, our health researchers have supported the Centers for Disease Control and Prevention’s (CDC) National HIV Behavioral Surveillance (NHBS) study of men at risk for HIV. But little was known about the epidemiology of HIV infection among the transgender population in the U.S. And particularly among transgender women (transwomen) who are disproportionately affected by the disease. Until now.  
“Many trans people still struggle with those who deny our existence. The effort and dedication I’ve seen poured into this project tells me that the world is beginning to listen to us.” — Evelyn Olansky

Understanding the trans community

The first-ever NHBS-Trans study sets a baseline for monitoring sexual behaviors among transwomen—with the ultimate goal of lowering the number of new HIV infections among this population.  

Leading this groundbreaking work is our own transgender expert and public health researcher Evelyn Olansky, who is transgender herself. “The first success of the NHBS-Trans study is how it affirms transgender lives,” she says.  
Source: Centers for Disease Control and Prevention

Significant initial findings  

Evelyn and her team conducted the initial formative research then identified and interviewed 1,608 transgender women in seven cities with high levels of HIV cases. This sample represented one of the largest intentional samples of a trans population in the history of trans research.  

We also provided on- and off-site coordination, data management and coordination, and hands-on technical assistance throughout the study period. Evelyn, along with health data analysts Lindsay Trujillo and Anna Teplinskaya, were also part of the NHBS-Trans Study Group that prepared the report.   

“These results show how critical it is that HIV prevention and care efforts reach beyond traditional settings and are culturally informed and responsive to community needs.” — Centers for Disease Control and Prevention

The findings were significant—including that 42% of those interviewed already had HIV, highlighting the urgent need for more HIV prevention and treatment services for this population. 

The study also found that HIV was more common among Black/African American and Hispanic/Latina transgender women. And that many transwomen experience poverty and homelessness—factors that can affect overall health. 

Demetre Daskalakis, director of CDC’s Division of HIV/AIDS Prevention, shared in this press release, “These data provide a clear and compelling picture of the severe toll of HIV among transgender women and the social and economic factors that are contributing to this unacceptable burden.” 


Impact on future studies

Our work will help improve future efforts to reach trans populations and other hard-to-reach groups. Our team learned a lot about how to design and run projects focused on transgender people, particularly transwomen. Evelyn adds, “Anyone can work with transgender populations, but to work well, you need to have transgender people on your team.” 

While this HIV-focused report includes data on transgender women, many people across the trans and gender nonconforming spectrum face similar social and economic factors, the impacts of which remain largely unmeasured. 

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