There are many reasons for this. Anal sex, particularly condom-less receptive anal
intercourse, is a highly efficient mechanism for HIV infection. 24 Many transgender female
sex workers are attractive to men and, consistent with their female gender identity, they
tend to adopt a receptive sexual role for penetrative sex. 25 This puts transgender female
sex workers at a substantially greater risk of HIV infection than their partners, as the risk
of transmission is around 18 times higher than through vaginal intercourse. 26
The sexual relationship patterns of men who have sex with transgender women
also show many concurrent partners in diverse sexual networks, which presents
opportunities for HIV transmission across populations. In addition, emerging data
suggests that male partners of transgender women might be more likely to engage in
high-risk drug using behavior than drug users who do not partner with transgender
women. 27 Finally, hormones used for transitioning can result in erectile dysfunction and
interfere with correct condom use, thereby also increasing HIV risk during anal insertive
sex. 28
Inspite of these factors, transgender individuals are routinely overlooked in HIV/AIDS
programs in the Asia-Pacific Region.29 Transgender persons are usually not included
in epidemiological research, monitoring or intervention programs relating to HIV/
AIDS.30Transgender women are also often only included as a sub-population of MSM.
This is not only fundamentally at odds with the gender identity of transgender women,
but has also served to limit attention and resources to the unique HIV-related needs
of this population. It has also prevented the development of effective public health
interventions for this group of people.31
Globally, current HIV monitoring and prevention interventions for transgender people
are inadequate. Many transgender people cannot access existing interventions for
the general population, while there remain few programs targeted specifically for
transgender people. Inadequate country data has compounded these problems.32
UNAIDS has issued guidelines to help countries collect data and report national
response as effectively as possible but, unlike other key affected populations, for a very
long time, there was no guidance on collecting and reporting data about transgender
24 Tonia Poteat et al., “HIV risk and preventive interventions in transgender women sex workers.” The Lancet. (July 2014).
25 APTN, UNDP. “Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region”.
26 Ibid.
27 Tonia Poteat et al., “HIV risk and preventive interventions in transgender women sex workers.”