In a recently published report in JAIDS, Willi McFarland, MD, PhD and colleagues describe HIV seroconversion trends among trans women in San Francisco from 2017 – 2019 collected in the TransNational Study. Young trans women (aged 18 – 24) had a significantly higher HIV incidence, as did Latinx trans women and trans women of color. 

“Perhaps the most disheartening finding is the elevated HIV incidence among young trans women,” the authors said. “The nearly four-fold higher incidence among transgender youth predicts a continuing high burden of infection for years to come.” 

“San Francisco is a small city with a lot of services for trans folks,” said Erin Wilson, DrPh, MPH, who reported some results from the study at IAS 2019. “This substantial transmission continues despite unparalleled access to gender-affirming medical procedures and social services.” 

The TransNational Study enrolled a total of 415 HIV-negative trans women, with 377 completing the 18-month study. Over the course of the study, participants received HIV testing, referrals to PrEP, and referrals to HIV care (for those who tested positive during the study). There were eight seroconversions that occurred over the course of the study, for an overall incidence rate of 1.3 per 100 person years (py). 

The trans women who seroconverted were significantly more likely to be young, identify as Latinx or a trans woman of color, have a history of incarceration, and be without health insurance. 

Young trans women ages 18 – 24 had an HIV incidence rate significantly higher than trans women who were older (3.7 per 100 py versus 1.2 per 100 py). Latinx trans women (2.6 per 100 py) and trans women of color (2.2 per 100 py) had significantly higher incidence rates than white trans women. Trans women who had been incarcerated (2.3 per 100 py) and those without health insurance (5.8 per 100 py) also experienced higher HIV incidence rates. 

“Structural factors disproportionately affecting trans women of color are also tied to poor HIV care outcomes and suboptimal access to HIV prevention use,” the authors said. “Such risks are exacerbated in our city, which has wide disparities in wealth, housing and employment opportunities.” 

Reference:

McFarland, W. and colleagues. High HIV Incidence Among Young and Racial/Ethnic Minority Transgender Women in San Francisco. JAIDS, May, 2020. 

Hear more from Erin Wilson, DrPH, MPH

Erin Wilson, DrPH, MPH shares research conducted with trans women in San Francisco, and explains why simply providing accessible gender-affirming services and HIV prevention and care isn’t enough to offset the inequities, discrimination and disadvantages that trans women may experience.

Resources for trans women in San Francisco: 

STRIDE: Transgender Hormone Therapy Program at St. James Infirmary

St. James Infirmary provides gender-affirming hormone therapy to participants. Check the schedule for services during COVID-19.

Trans Health at San Francisco AIDS Foundation 

You can access a variety of gender-affirming care options including hormone prescriptions, hormone level checks, and hormone injection assistance, in addition to peer support through our TransLife social support program.  

Transgender Clinic of Tom Waddell Health Center

In addition to gender-affirming care, you can access multidisciplinary primary care for all medical issues (not just issues related to gender), and mental health and social services. Call the voicemail line at 415-355-7588 for info about services during COVID-19. 

Transgender Health at San Francisco Community Health Center 

Access gender-affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, or chest binding. Trans Thrive is currently suspended during COVID-19, but essential health services are being provided essential services to trans and gender non-conforming community members. 

Lyon Martin Health Services

Access medical care, sexual and reproductive health care, and gender-affirming care. Lyon Martin is currently open during COVID-19. Call 415-565-7667 to make an appointment.