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In Their Own Words: How Trans Women Acquired HIV Infection


Despite high HIV prevalence, the reasons trans women acquire HIV are not well understood. Trans women are often mis-classified or aggregated with men who have sex with men (MSM) in epidemiologic studies and HIV surveillance data. Trans women enrolled in the 2019/2020 National HIV Behavioral Surveillance Study in San Francisco were asked an open-ended question about how they were infected with HIV. The most common responses were “Sex with a straight cisgender man partner when the respondent identified as a trans woman” (43.0%); “Sexual assault” (13.9%); “Injection drug use (IDU)” (10.1%); “IDU or sexual contact” (7.6%) and “Sex with a partner who injected drugs” (7.6%). Sex with a cisgender man partner prior to identifying as a trans women (MSM contact) was not mentioned by any respondent. HIV prevention strategies targeting MSM will fail to reach trans women and many of their cisgender men partners.


A pesar de la alta prevalencia del VIH, las razones por las que las mujeres trans adquieren el VIH no se comprenden bien. Las mujeres trans a menudo se clasifican erróneamente o se agregan a los hombres que tienen sexo con hombres (HSH) en los estudios epidemiológicos y en los datos de vigilancia del VIH. A las mujeres trans inscritas en el Estudio Nacional de Vigilancia del Comportamiento del VIH 2019/2020 en San Francisco se les hizo una pregunta abierta sobre cómo se infectaron con el VIH. Las respuestas más comunes fueron "Sexo con una pareja heterosexual de hombre cisgénero cuando el encuestado se identificó como una mujer trans" (43,0%); “Agresión sexual” (13,9%); “Uso de drogas inyectables (UDI)” (10,1%); “UDI o contacto sexual” (7,6%) y “Sexo con pareja que se inyecta drogas” (7,6%). Ningún encuestado mencionó el sexo con una pareja hombre cisgénero antes de identificarse como mujer trans (contacto HSH). Las estrategias de prevención del VIH dirigidas a los HSH no llegarán a las mujeres trans ni a muchas de sus parejas masculinas.

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We acknowledge the trans women who shared, in their own words, their experiences, insights and personal stories regarding how they acquired HIV infection.


Funding for this project and analysis was provided by the Centers for Disease Control and Prevention, award # NU62PS005077 and the National Institutes of Health, Award # R01MD010678. The funders (i.e., the Centers for Disease Control and Prevention and the National Institutes of Health) did not review this manuscript to determine whether authorized for submission to the journal. The interpretations and views herein are those of the authors.

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Correspondence to Erin C. Wilson.

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The study protocol was reviewed and approved by the Institutional Review Board (IRB) at the University of California, San Francisco (UCSF) (#17-24062).

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Wilson, E.C., Hernandez, C.J., Arayasirikul, S. et al. In Their Own Words: How Trans Women Acquired HIV Infection. AIDS Behav 26, 2091–2098 (2022).

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  • Transgender persons
  • HIV acquisition
  • Trans women
  • Sexual violence