Several factors, including discrimination, homelessness and violence, help explain why transgender women—especially women of color—have a higher risk for HIV, according to a collection of seven reports from the Centers for Disease Control and Prevention.

The findings come from the National HIV Behavioral Surveillance Among Transgender Women project, which surveyed more than 1,600 participants in seven U.S. cities during 2019–2020. Around two thirds were living in poverty, 42% had experienced homelessness during the past year and a third had exchanged sex for money or drugs. Most (70%) said they had experienced trans-related discrimination, and over half reported gender-based violence, abuse or harassment. More than a quarter reported recent psychological distress, and 18% said they had considered suicide during the past year. Those who reported social disadvantages, substance use or psychological distress were more likely to say they had condomless sex.

Among those surveyed, 42% had been diagnosed with HIV, but this varied by race/ethnicity: 62% of Black trans women, 35% of Latina women and 17% of white women were HIV positive. Most trans women diagnosed with HIV (90%) were currently on antiretroviral treatment. Over 90% of HIV-negative respondents knew about pre-exposure prophylaxis (PrEP), and nearly 60% had discussed it with a health care provider, but only 32% had recently used it.