UK study highlights discrimination against trans people living with HIV
Roy Trevelion, HIV i-Base
The first study to measure stigma and discrimination in health and social care towards trans people in the UK was published this month.  This is much needed, it reports on stigma generally for trans people, and on increased risk factors for HIV.
The community-led HIV StigmaSurvey UK 2015 investigated experiences of people living with HIV in the past 12 months. The anonymous online survey went out to over 120 community organisations and 46 HIV clinics to people aged over 18.
Trans participants self-identified via questions on gender identity and gender at birth. The term cisgender referred to people who identified with the gender they were assigned at birth.
31 out of 1576 participants identified as trans. There were 19 trans women, 5 trans men, 2 gender queer/non binary, and 5 other. Multivariate analysis was used to identify social and demographic predictors of being treated differently to non-HIV patients. High levels of social stigma were reported for trans compared to cisgender. Respectively, there were 39% vs 23% worrying about verbal harassment, and 23% vs 9% with exclusion from family gatherings. 10% of trans participants reported physical assault within the last 12 months, compared to 4% of cisgender participants.
High levels of stigma and discrimination were reported in healthcare settings. Trans people reported being treated differently to non-HIV patients with 48% vs 30% (aOR 2,61, CI 1.06, 6.42) respectively, and 41% vs 16% (aOR 4.58, CI 1.83, 11.44) being delayed or refused healthcare.
Findings highlighted several notable factors for increased risk of HIV for trans people. In the past 12 months 29% vs 13% reported ever injected drug use for trans vs cisgender respectively. In the same period 39% vs 12% (trans vs cisgender) reported ever been paid for sex.
The findings call for increased awareness and training of healthcare staff around trans/non binary issues. Health services need to address multiple and complex needs of trans people living with HIV. This includes additional increased risk of HIV from injecting drug use and experiences of transactional sex.
Further research is needed to explore stigma and discrimination for trans people. This research should be inclusive of trans not only because of increased risk of HIV, but also for trans rights, understanding and representation in the wider community. Trans people should be included in all areas of research where gender information is collected.
In the UK, trans women are 49 times more likely to have HIV. This study confirms that clinical training programmes within the NHS must include trans/non binary issues. This awareness is important for HIV treatment and care, and also for PrEP and HIV prevention for all trans people.
A new report from Stonewall also highlights transgender experiences in the UK. 
1. Hibbert M et al. Experiences of stigma and discrimination in social and healthcare settings among trans people living with HIV in the UK. AIDS Care 2018 Feb 6:1-8. doi:10.1080/09540121.2018.1436687. (February 2018).
2. LGBT in Britain: Trans report (2018)