How to Fix the Misclassification of Trans Women

While transgender women are the most at-risk population for HIV, they are often the most overlooked when it comes to HIV research and prevention. Although it is known that trans women have some of the highest rates of HIV transmission in the U.S., this demographic has often been incorrectly categorized as men who have sex with men in HIV research. Now, researchers are looking to capture more accurate data on trans women and HIV so that this population can get the attention and care they need.

A few years ago, transgender issues took center stage at the National HIV Prevention Conference (NHPC) for the first time in 2015. The conference, sponsored by the Center for Disease Control and Prevention, discussed a host of issues related to trans health issues, but possibly the most important finding was a study presented by Mesfin Mulatu from the CDC’s Program evaluation branch on HIV testing, transmission rates, and linkage to care among trans people.

Previously, data on those who take part in HIV research was collected using the traditional “one-step” approach. Under this collection method, researchers would categorize participants based on only their current gender identity. This required the individual to choose from limited options and often resulted in a misclassification of trans people. A prime example of the error of this method is the iPrEX trial for Truvada as PrEP in which trans women were classified under “men who have sex with men.”

The two-step approach, however, allows for the participant to differentiate between the gender assigned at birth and their current gender. The study found that this method was far more accurate in the identification of trans people in HIV research.

In Mulatu’s study, most of the participants were cisgender (or non-trans) men and women. Using the one-step method for gender data collection, 10,201 participants were identified as trans women (0.03 percent), 1,769 were identified as trans men (0.03 percent), and 515 identified as unspecified transgender or other (0.01 percent). Under the two-step method, however, researchers were able to identify an additional 5,363 trans women and 3,244 trans men, resulting in 69 percent increase in transgender identification.

Mulatu noted that trans people face a host of barriers when it comes to HIV treatment in prevention including stigma, discrimination, violence, poverty, unstable housing, and mental illness. Given that trans women are more than 50 times more likely to be HIV-positive, it is crucial that HIV researchers and prevention specialists continue to focus on better ways to assess and treat this at-risk population.