Why transgender people are less likely to get tested for HIV and what it means for all of us

Have you ever wondered why some groups of people get tested for HIV less often, even when the risk of infection is high? Here's a familiar situation: your friend says it's time to get tested, but he keeps putting it off. Too much work, or too scary. Now imagine that you also face stigma and uncertainty about how a doctor will treat you if you are transgender or non-binary. This is what New Zealand researchers found when they included transgender people in their survey on sexual behavior and HIV prevention for the first time.

Scientists from New Zealand conducted a survey among transgender and non-binary people who had sex with gay, bisexual, or other men. They compared their responses with those of cisgender gay and bisexual men. It turned out that transgender participants were on average younger, more likely to face financial difficulties, and more likely to have a disability. But most importantly, they were less likely to have had an HIV test in the past 12 months. And among transgender men and non-binary people assigned female at birth, they were also less likely to take pre-exposure prophylaxis (PrEP) — pills that protect against HIV.

Why is this happening?

The study authors suggest that the reason is not that these people are at lower risk. Rather, there are barriers: perhaps they have more difficulty accessing a doctor who understands their specific needs, or they fear negative experiences. Indeed, survey participants reported more negative experiences with healthcare providers. Additionally, a higher proportion of them used injection drugs, which also increases the risk of HIV transmission.

An important nuance: the behavior of different groups of transgender people differed. Transgender women and non-binary people assigned male at birth behaved sexually much like cisgender gay men. In contrast, transgender men and non-binary people assigned female at birth had fewer male partners and more sex with women and other non-binary people. This suggests that transgender people cannot be treated as a single group — each has its own risks and needs.

Regarding testing for other sexually transmitted infections, there were almost no differences — all were equally likely to get tested. And only a few participants were living with HIV. But HIV testing and PrEP remain important prevention tools, and if transgender people use them less often, they may be missing opportunities to protect themselves.

What to do?

If you are transgender or non-binary and have had sexual contact with men, don't delay getting tested for HIV and other STIs. It's not scary; it's self-care. Look for clinics with LGBTQ+-friendly providers, or ask in local communities where to go. And if you are a healthcare provider or just a friend, remember: support and understanding can make a crucial difference. Ask if they need help, offer to go with them for a test. Sometimes a friendly word can be enough for someone to take a step toward their health.