PolicyLab

I first met Ayanna*, a young transgender woman (meaning she was assigned to the male sex at birth, but identifies as female), when she was 16. She had just been released from a juvenile detention center and was referred to me for treatment because of a positive HIV test.

During her first visit, I learned so much about the challenges she faced due to her gender identity and new HIV diagnosis. She had a history of abuse and neglect from her biological family, who were not supportive of her identity. She was engaging in “survival sex” (trading sex for money, food or a place to stay) in order to pay for street procedures (e.g., silicone injections) and hormones, both of which she thought she could never get from a doctor. She was also facing physical violence from sexual partners and harassment from the police and other authorities.

Thankfully, our multidisciplinary team has been able to provide Ayanna with the medical care she needs for her HIV infection, as well as gender-affirming hormone therapy in a safe and supportive environment. But, she still faces many obstacles when she leaves our clinic. While I continue to treat Ayanna today, I can go months, or even a year, without seeing her due to changes in her life, such as homelessness or incarceration for prostitution charges. Despite all of her challenges, I am constantly amazed by her resilience and her ability to survive and face life’s challenges on her own – something no young person should have to do.

Tragically, more than eight transgender women of color have been murdered already in the U.S. this year. The majority of these individuals were young people under the age of 24 who had full lives ahead of them.

While national awareness of the violence and discrimination experienced by this population has thankfully increased in recent years, there has still been limited attention to the serious health challenges faced by young transgender women (YTW) of color. Despite improvements in the numbers of new infections in the U.S., as many as one in four YTW of color are living with HIV/AIDS in this country. In one of our recent studies of YTW in Philadelphia, we found that more than half of participants reported moderate to severe symptoms of depression, and more than 15 percent got their medically necessary hormones from a source other than a medical provider — most likely on the street. 

If we are to prevent new HIV infections among this vulnerable population, strategies will need to include PrEP — or Pre-exposure Prophylaxis — which involves taking one pill daily that works as well as most vaccines in preventing HIV. However, our recent study published in Journal of Adolescent Health suggests that many YTW still don’t know that PrEP exists and that their medical providers failed to discuss it with them. 

On this National Youth HIV and AIDS Awareness Day, we call for increased efforts to provide high-quality gender-affirming medical and mental health care integrated with state-of-the-art HIV prevention and treatment for this vulnerable population. Please join us in our commitment to ensure that no young transgender woman, like Ayanna, has to fear for her life and that she has access to health care that is necessary for her well-being. 

Click here to learn more about the CHOP Adolescent HIV Clinic and CHOP Gender and Sexuality Development Clinic. 

* Name has been changed to protect patient privacy