The Intersection of Transgender Identities, HIV, and Aging

  • Kristen E. Porter
  • Mark Brennan-Ing


The Centers for Disease Control and Prevention cites the highest rates of HIV infection are found in the transgender population (Centers for Disease Control and Prevention, MMWR Morb Mortal Wkly Rep 65(40):1099–1103, 2016), yet little is known about older transgender adults with HIV. A national transgender survey reports HIV rates nearly five times those of the general US population (James et al., The report of the 2015 US transgender survey. National Center for Transgender Equality, Washington, DC, 2016). Of transgender people with HIV, around 84% are transgender women, 15% are transgender men, and 1% non-binary/other gender identity (Centers for Disease Control and Prevention, MMWR Morb Mortal Wkly Rep 65(40):1099–1103, 2016). Racial disparities are significant, with more than half of African-American transgender women HIV-infected (Centers for Disease Control and Prevention, MMWR Morb Mortal Wkly Rep 65(40):1099–1103, 2016). Approximately 3% of people with HIV aged 55 and older are transgender (Clark et al., AIDS Behavior 21:2774–2783, 2017). Transgender older adults with HIV face numerous health disparities which can be considered in the proposed Five Corners intersectionality framework. Models of care that address transgender individuals with HIV are being developed to address the unique needs of these populations. Despite these challenges, older adults with HIV and older transgender adults report high levels of resilience: an important personal resource to be leveraged in clinical care or social service programs. Providers must be prepared to competently serve the diverse population of older adults with HIV, which includes those with transgender experience.


HIV AIDS Intersectionality Multimorbidity Five Corners Care models 


  1. 1.
    Karpiak SE, Brennan M. The emerging population of older adults with HIV and introduction to the ROAH study. In: Older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science Publishers; 2009. p. 1–2.Google Scholar
  2. 2.
    High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, Deren S, Effros RB, Gebo K, Goronzy JJ, Justice AC. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr (1999). 2012;60(Suppl 1):S1–18.Google Scholar
  3. 3.
    amfAR: Thirty years of HIV/AIDS: Snapshots of an epidemic [Internet]. 2013. Accessed 27 Jan 2018.
  4. 4.
    Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17–25.CrossRefGoogle Scholar
  5. 5.
    Diverse Elders Coalition. Eight policy recommendations for improving the health and wellness of older adults with HIV [Internet]. 2014. Accessed 27 Jan 2018.
  6. 6.
    Centers for Disease Control and Prevention. HIV among people aged 50 and 0lder [Internet]. 2017. Accessed 27 Jan 2018.
  7. 7.
    ACRIA. Age is not a condom [Internet]. Accessed 27 Jan 2018.
  8. 8.
    Brennan-Ing M, Seidel L, Ansell P, Raik BL, Greenberg D, Nicastri C, Breznay J, Karpiak SE, Adelman RD. Addressing sexual health in geriatrics education. Gerontol Geriatr Educ. 2017;17:1–5.Google Scholar
  9. 9.
    Stoff DM, Khalsa JH, Monjan A, Portegies P. Introduction. AIDS [Internet]. Ovid Technol (Wolters Kluwer Health). 2004;18(Supplement 1):1–2. Available from: Scholar
  10. 10.
    Dragon CN, Guerino P, Ewald E, Laffan AM. Transgender Medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT health. 2017;4(6):404–11.CrossRefGoogle Scholar
  11. 11.
    Brown GR, Jones KT. Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: a case–control study. LGBT health. 2016;3(2):122–31.CrossRefGoogle Scholar
  12. 12.
    Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ. Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. Am J Psychiatr. 2004;161(5):912–4.CrossRefGoogle Scholar
  13. 13.
    Shrier LA, Harris SK, Sternberg M, Beardslee WR. Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Prev Med. 2001;33(3):179–89.CrossRefGoogle Scholar
  14. 14.
    Plotzker RE, Metzger DS, Holmes WC. Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: a potential mediating pathway. Am J Addict. 2007;16(6):431–8.CrossRefGoogle Scholar
  15. 15.
    Johnson SD, Cunningham-Williams RM, Cottler LB. A tripartite of HIV-risk for African American women: the intersection of drug use, violence, and depression. Drug Alcohol Depend. 2003;70(2):169–75.CrossRefGoogle Scholar
  16. 16.
    James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi MA. The report of the 2015 US transgender survey. Washington, DC: National Center for Transgender Equality; 2016.Google Scholar
  17. 17.
    Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, Erosheva EA, Emlet CA, Hoy-Ellis CP, Goldsen J, Muraco A. Physical and mental health of transgender older adults: an at-risk and underserved population. The Gerontologist. 2013;54(3):488–500.CrossRefGoogle Scholar
  18. 18.
    Erenrich R, Seidel L, Karpiak S, Brennan-Ing M, Lunievicz J. Research on older adults with HIV: Bay Area focus group report: Alameda County and San Francisco. New York: ACRIA; 2017.Google Scholar
  19. 19.
    Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I don't think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. J Assoc Nurses AIDS Care. 2009;20(5):348–61.CrossRefGoogle Scholar
  20. 20.
    Walker RV, Powers SM, Witten TM. Impact of anticipated bias from healthcare professionals on perceived successful aging among transgender and gender nonconforming older adults. LGBT Health. 2017;4(6):427–33.CrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention. CDC-funded HIV testing: United States, Puerto Rico, & the U.S. Virgin Islands. 2014. MMWR Morb Mortal Wkly Rep. 2016;65(40):1099–103.CrossRefGoogle Scholar
  22. 22.
    Crenshaw, K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics, U Chic Legal F. 1989:139(1), Article 8. Available at:
  23. 23.
    Taskforce AL, Harper A, Finnerty P, Martinez M, Brace A, Crethar HC, Loos B, Harper B, Graham S, Singh A, Kocet M. Association for Lesbian, gay, bisexual, and transgender issues in counseling competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex, and ally individuals: approved by the ALGBTIC board on June 22, 2012. J LGBT Issues Couns. 2013;7(1):2–43.CrossRefGoogle Scholar
  24. 24.
    Witten TM. The intersectional challenges of aging and of being a gender non-conforming adult. Generations. 2016;40(2):63–70.Google Scholar
  25. 25.
    Kleyman P. Senior power: growing old rebelliously: Glide Publications; San Francisco. 1974.Google Scholar
  26. 26.
    Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV infection in transgender adults and adolescents: results from the national HIV surveillance system, 2009–2014. AIDS Behav. 2017;21(9):2774–83.CrossRefGoogle Scholar
  27. 27.
    Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. HIV/AIDS prevention research synthesis team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–7.CrossRefGoogle Scholar
  28. 28.
    Porter KE, Brennan-Ing M, Burr JA, Dugan E, Karpiak SE. Stigma and psychological well-being among older adults with HIV: the impact of spirituality and integrative health approaches. The Gerontologist. 2015;57(2):219–28.Google Scholar
  29. 29.
    Emlet CA. Stigma in an aging context. In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 144–58.Google Scholar
  30. 30.
    Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using multiple-hierarchy stratification and life course approaches to understand health inequalities: the intersecting consequences of race, gender, SES, and age. J Health Soc Behav. 2016;57(2):200–22.CrossRefGoogle Scholar
  31. 31.
    Witten TM, Eyler AE, editors. Gay, lesbian, bisexual, and transgender aging: challenges in research, practice, and policy: JHU Press; San Francisco. 2012.Google Scholar
  32. 32.
    DeMarco RF, Brennan-Ing M, Sprague C, Brown SM. Ageism, aging and HIV: community responses to prevention, treatment, care and support. In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 234–9.Google Scholar
  33. 33.
    Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRefGoogle Scholar
  34. 34.
    Mizuno Y, Frazier EL, Huang P, Skarbinski J. Characteristics of transgender women living with HIV receiving medical care in the United States. LGBT health. 2015;2(3):228–34.CrossRefGoogle Scholar
  35. 35.
    Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915.CrossRefGoogle Scholar
  36. 36.
    Denson DJ, Padgett PM, Pitts N, Paz-Bailey G, Bingham T, Carlos JA, McCann P, Prachand N, Risser J, Finlayson T. Health care use and HIV-related behaviors of black and Latina transgender women in 3 US metropolitan areas: results from the transgender HIV behavioral survey. J Acquir Immune Defic Syndr. 2017;75:S268–75.CrossRefGoogle Scholar
  37. 37.
    Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008;48(1):97–103.CrossRefGoogle Scholar
  38. 38.
    Das M, Chu PL, Santos GM, Scheer S, Vittinghoff E, McFarland W, Colfax GN. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. 2010;5(6):e11068.CrossRefGoogle Scholar
  39. 39.
    Rebchook G, Keatley J, Contreras R, Perloff J, Molano LF, Reback CJ, Ducheny K, Nemoto T, Lin R, Birnbaum J, Woods T. The transgender women of color initiative: implementing and evaluating innovative interventions to enhance engagement and retention in HIV care. Am J Public Health. 2017;107(2):224–9.CrossRefGoogle Scholar
  40. 40.
    Centers for Disease Control and Prevention. National HIV/AIDS strategy: updated to 2020 2015. Retrieved from
  41. 41.
    Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care. 2010;21(3):256–64.CrossRefGoogle Scholar
  42. 42.
    Lemons A, Beer L, Finlayson T, McCree DH, Lentine D, Shouse RL. Medical monitoring project. Characteristics of HIV-positive transgender men receiving medical care: United States, 2009–2014. Am J Public Health. 2018;108(1):128–30.CrossRefGoogle Scholar
  43. 43.
    Nasi M, Pinti M, De Biasi S, Gibellini L, Ferraro D, Mussini C, Cossarizza A. Aging living with HIV infection: a journey to the center of inflammAIDS, immunosenescence and neuroHIV. Immunol Lett. 2014;162(1):329–33.CrossRefGoogle Scholar
  44. 44.
    Brown TT, Guaraldi G. Multimorbidity and burden of disease. In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 59–73.Google Scholar
  45. 45.
    Havlik RJ, Brennan M, Karpiak SE. Comorbidities and depression in older adults with HIV. Sex Health. 2011;8(4):551–9.CrossRefGoogle Scholar
  46. 46.
    Marin B, Thiébaut R, Bucher HC, Rondeau V, Costagliola D, Dorrucci M, Hamouda O, Prins M, Walker AS, Porter K, Sabin C. Non-AIDS-defining deaths and immunodeficiency in the era of combination antiretroviral therapy. AIDS (London, England). 2009;23(13):1743.CrossRefGoogle Scholar
  47. 47.
    Karpiak SE, Havlik R. Are HIV-infected older adults aging differently? In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 11–27.Google Scholar
  48. 48.
    Pathai S, Bajillan H, Landay AL, High KP. Is HIV a model of accelerated or accentuated aging? J Gerontol A: Biomed SciMed Sci. 2013;69(7):833–42.CrossRefGoogle Scholar
  49. 49.
    Althoff KN, McGinnis KA, Wyatt CM, Freiberg MS, Gilbert C, Oursler KK, Rimland D, Rodriguez-Barradas MC, Dubrow R, Park LS, Skanderson M. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis. 2014;60(4):627–38.CrossRefGoogle Scholar
  50. 50.
    Applebaum A, Brennan M. Mental health and depression. In: Older adults with HIV: An in-depth examination of an emerging population. New York: Nova Science Publishers; 2009. p. 27–34.Google Scholar
  51. 51.
    Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010;22(5):630–9.CrossRefGoogle Scholar
  52. 52.
    Safren SA, Hendriksen ES, Mayer KH, Mimiaga MJ, Pickard R, Otto MW. Cognitive-behavioral therapy for HIV medication adherence and depression. Cogn Behav Pract. 2004;11(4):415–24.CrossRefGoogle Scholar
  53. 53.
    American Psychological Association. Task Force on Gender Identity and Gender Variance. Report of the task force on gender identity and gender variance. Washington, DC: Author; 2009. Retrieved from Scholar
  54. 54.
    Alberts LH. Polypharmacy, using new treatments to customize care for aging patients and adherence present and future. In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 74–84.Google Scholar
  55. 55.
    Williamson C. Providing care to transgender persons: a clinical approach to primary care, hormones, and HIV management. J Assoc Nurses AIDS Care. 2010;21(3):221–9.CrossRefGoogle Scholar
  56. 56.
    Singh HK, Del Carmen T, Freeman R, Glesby MJ, Siegler EL. From one syndrome to many: incorporating geriatric consultation into HIV care. Clin Infect Dis. 2017;65(3):501–6.CrossRefGoogle Scholar
  57. 57.
    Siegler EL, Brennan-Ing M. Adapting systems of care for people aging with HIV. J Assoc Nurses AIDS Care. 2017;65(3):501–6.Google Scholar
  58. 58.
    Sangarlangkarn A, Avihingsanon A, Appelbaum JS. Application of geriatric principles and care models in HIV and aging. In: HIV and aging, vol. 42: Karger Publishers; San Francisco. 2017. p. 119–33.Google Scholar
  59. 59.
    Boult C, Wieland GD. Comprehensive primary care for older patients with multiple chronic conditions: “nobody rushes you through”. JAMA. 2010;304(17):1936–43.CrossRefGoogle Scholar
  60. 60.
    Dickey LM. Toward developing clinical competence: improving health care of gender diverse people. Am J Public Health. 2017;107(2):222–3.CrossRefGoogle Scholar
  61. 61.
    Ernst J, Fusaris E. Providing access to medical, surgical, and behavioral health services for people of transgender experience in Medicaid managed care: A case study. Paper presented at the Gay and Lesbian Medical Association annual conference on LGBT health. 2017 Sept. 16.Google Scholar
  62. 62.
    Porter KE, Brennan-Ing M, Chang SC, Dickey LM, Singh AA, Bower KL, Witten TM. Providing competent and affirming services for transgender and gender nonconforming older adults. Clin Gerontol. 2016;39(5):366–88.CrossRefGoogle Scholar
  63. 63.
  64. 64.
    Hughes A, Davies B, Gudmundsdottir M. “Can you give me respect?” experiences of the urban poor on a dedicated AIDS nursing home unit. J Assoc Nurses AIDS Care. 2008;19(5):342–56.CrossRefGoogle Scholar
  65. 65.
    Sears B. HIV discrimination in health care services in Los Angeles County: the results of three testing studies. Wash Lee J Civil Rts Soc Just. 2008;15:85.Google Scholar
  66. 66.
    Stringer KL, Turan B, McCormick L, Durojaiye M, Nyblade L, Kempf MC, Lichtenstein B, Turan JM. HIV-related stigma among healthcare providers in the deep south. AIDS Behav. 2016;20(1):115–25.CrossRefGoogle Scholar
  67. 67.
    Porter KE, Ronneberg CR, Witten TM. Religious affiliation and successful aging among transgender older adults: findings from the trans MetLife survey. J Relig Spiritual Aging. 2013;25(2):112–38.CrossRefGoogle Scholar

Recommended Reading

  1. American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015;70(9):832–64.CrossRefGoogle Scholar
  2. Brennan-Ing M, DeMarco RF, editors. HIV and aging: Karger Medical and Scientific Publishers; 2017.Google Scholar
  3. Porter KE, Brennan-Ing M, Chang SC, Dickey LM, Singh AA, Bower KL, Witten TM. Providing competent and affirming services for transgender and gender nonconforming older adults. Clin Gerontol. 2016;39(5):366–88.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Kristen E. Porter
    • 1
  • Mark Brennan-Ing
    • 2
    • 3
  1. 1.Zen Executive LLCBostonUSA
  2. 2.Brookdale Center for Healthy Aging, Hunter College, The City University of New YorkNew YorkUSA
  3. 3.Rory Meyers College of Nursing, New York UniversityNew YorkUSA

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