New Federal Actions to Address HIV in the Transgender Community

Transgender communities in the United States are among the groups at highest risk for HIV infection. The National HIV/AIDS Strategy (NHAS) observes that, historically, our efforts focused on this population have been limited, but that the federal government has made strides in improving our response since 2010. Urging that we remain vigilant in increasing knowledge and appropriate support and interventions for this population, the Strategy rightly includes transgender women, especially Black transgender women, among the populations disproportionately affected by HIV for and with whom we must prioritize interventions.

Transgender leaders and their allies have been working to raise awareness about the unmet HIV prevention and care needs in the transgender community and to improve programs, policies, and data supported by the federal government. They have pressed the federal government, and the HIV community more broadly, to be more thoughtful and thorough in our follow through on the parts of the Strategy that are most important for improving the health of transgender persons living with HIV and preventing new HIV infections in this population.

Over the past several months, we and colleagues from CDC, HRSA, and the White House Office of National AIDS Policy have had the opportunity to engage in a number of conversations – including a White House meeting on HIV in the transgender community – during which we heard from transgender women and men about their experiences and recommendations for improving the response to HIV in the transgender community. The data and lived experiences they brought to these meetings were compelling.

The White House meeting and subsequent discussions have identified a variety of on-going efforts to reduce HIV risk and improve health among transgender persons from across several HHS agencies. These discussions also resulted in specific new steps that could be taken in the near-term and down the road to continue and expand efforts to improve our nation’s HIV prevention and care efforts for transgender people. We are pleased to share an update on several of these new activities that are underway or about to begin:

• With resources from the Secretary’s Minority AIDS Initiative Fund, HRSA’s HIV/AIDS Bureau (HAB) will fund a new training program in FY16 to support leadership development and build capacity among people living with HIV from disproportionately affected groups of people of color, including transgender women. The HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) will provide additional resources to support expansion of the program to specifically increase the participation of transgender women of color as part of this three-year effort.

• An ad hoc subgroup of the NHAS Federal Interagency Workgroup is developing an indicator for HIV in transgender populations. The indicator is expected to be finalized this calendar year and data included in the 2016 NHAS Progress Report.

• OHAIDP will conduct a review of HHS-supported HIV activities for transgender persons to document both programs and research that are currently funded and identify potential gaps. The review will be completed by the end of this calendar year and released online.

• CDC has taken important steps to improve how HIV-funding to serve transgender communities is awarded. New funding opportunity announcements seeking specifically to improve HIV outcomes among transgender persons will no longer be combined with those serving men who have sex with men (MSM), whenever feasible. If it is not feasible to have separate funding announcements, scoring criteria will include elements that clearly address applicants’ ability to reach transgender persons and provide high quality, culturally appropriate services. Such criteria might include experience of the program manager and staff in providing services to transgender populations and/or a plan to ensure competent staff.

• CDC will expand the National HIV Behavioral Surveillance, which conducts behavioral surveillance among persons at high risk for HIV infection, to include the transgender population. Specifically, CDC proposes to fund up to 10 sites, depending on the availability of funds, for a project period from January 1, 2017 to October 31, 2018.

• CDC will expand the scope of its HIV Prevention Capacity Building Assistance (CBA) Program to provide technical assistance to health departments and community-based organizations (CBOs) serving transgender populations, especially CBOs serving transgender women of color.

• A CDC/DHAP work group is exploring the possibility of developing activities to support capacity building/development of transgender organizations, with a particular focus on organizations serving transgender persons of color and transgender persons in the South.

• OHAIDP will confer with transgender HIV advocates and representatives of HHS agencies to discuss priorities for a potential FY17 demonstration project supported by the SMAIF that would seek to improve HIV prevention and care for transgender women of color.

We expect that these efforts will expand and enhance the HIV prevention and care services available to transgender people across the nation. We are hopeful that they will motivate partners – including health departments, health systems, clinicians, CBOs, faith communities, employers and others – to consider what steps they might take to augment and further strengthen their own efforts so that together we better serve this population that has suffered too many injustices for too long.