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Improving Quality and Access to Gender-affirming HIV Prevention Care for Transgender Youth

Statement of Problem

As many as 1% of individuals in the U.S. identify as transgender or gender expansive, and among adolescents and young adults, estimates are as high as 2.7%. Transgender children and adolescents often lack access to appropriate care, including affirming identity through appropriate use of preferred names and pronouns, puberty blockers, hormones, and other recommended medical and surgical treatments. In fact, in a large national survey, nearly half of transgender individuals reported delaying or forgoing medical care due to concerns of being treated poorly.

Transgender youth also experience significant challenges to their physical and mental well-being, including alarming rates of HIV infection. While new HIV infections in the U.S. are decreasing, the rates of infection among young transgender women are likely stable or increasing. Compared to the average individual globally, transgender women are 49 times more likely to become infected with HIV. There are a multitude of factors that contribute to HIV infection vulnerability among young transgender women, but lack of gender-affirming medical care and lack of provider respect and supportive care environments are cited as two major barriers against young transgender women seeking care. While awareness of Pre-Exposure Prophylaxis (PrEP), a daily pill that prevents HIV infection recommended for people at high risk for contracting HIV, varies among young transgender women, many perceive that they cannot afford this treatment.


Improving Quality and Access to Gender-affirming HIV Prevention Care for Transgender Youth


The team will partner with local leaders to improve the ability of local systems and policies to support the health and well-being of transgender youth.

Next Steps

As of summer 2022, Dr. Dowshen and her team have completed the first aim as well as recruitment of youth quality evaluators, who are currently conducting mystery shopping visits and facility audits at local HIV testing sites. After data collection, the research team will create the site-specific feedback reports and work with the youth quality evaluators to identify general improvements in gender-affirming HIV testing and prevention. Their hope is that the findings from this study will lead to the development of a framework for future research on the quality of care for young transgender women.

This project page was last updated in June 2022.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Improving Quality and Access to Gender-affirming HIV Prevention Care for Transgender Youth [online]. Available at: [Accessed: plug in date accessed here].