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In a new HIV/AIDS report from the Centers for Disease Control, researchers say transgender women urgently need better access to health care and the prophylactic drug PrEP — but are being held back in large part by employment and housing discrimination.
The new data was published Tuesday in the CDC’s Morbidity and Mortality Weekly Report (MMWR), the agency’s weekly digest of public health information and recommendations. Researchers analyzed data from a 2019-2020 National HIV Behavioral Surveillance survey (referred to as NHBR-Trans) of more than 1,600 transgender women, a demographic among which HIV/AIDS has long been disproportionately high, especially for Black and Latina trans women. Among their other findings, the study’s authors found a correlation between anti-trans discrimination in housing and employment and an overall lack of access to healthcare.
“Employment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity, and survival sex work. These issues are interconnected,” researchers wrote. Seven in 10 respondents said they had experienced some form of anti-trans discrimination in the past year; 42% said they were fired or couldn’t find a job, while 14% said they had been denied housing. This discrimination, in turn, prevents many trans women from accessing quality healthcare from hormones to pre-exposure prophylaxis (PrEP), and exposes them to possible incarceration and violence, all of which heighten the risk of contracting HIV.
Crucially, discrimination and its effects are self-reinforcing. “When economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships,” the study authors explained. Lack of housing and healthcare can make it even more difficult to find a job, and as the NHBS study found, all those factors and more can push marginalized trans women into survival sex work and other behaviors or environments that carry a high risk of HIV exposure.
“This analysis […] demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment,” the authors concluded.
The CDC study also recommended that Medicaid programs be expanded and should explicitly cover gender-affirming care, noting that in states where Medicaid does not cover transition care, respondents were twice as likely to report difficulty finding a job. However, the authors cautioned that such programs have typically been “shaped by structural racism, which has contributed to health inequities among Black and Hispanic persons,” leading to avoidance and a lack of community trust. The study also identified decriminalizing sex work as one way to reduce trans incarceration and associated negative health outcomes.
