Patterns of HIV acquisition are different for transgender women compared to men who have sex with men (MSM), a phylogenetic analysis of the virus in 275 trans women receiving care at public health clinics in San Francisco, California, that was reported in AIDS found.
Specifically, transgender women's HIV was clustered mainly with people who inject drugs (PWID) and men who have sex with both transgender and cisgender women. However, some participants' virus was connected to MSM networks, possibly because these women acquired HIV before they identified as transgender or when they were early in their transition.
The transwomen whose virus was linked to PWID may have acquired HIV through shared needles, or through sex with people who acquired HIV from drug injection equipment, researchers found. Clusters that included bisexual men may indicate multiple women having sex with the same man, study authors hypothesized.
The authors noted that both transgender people and PWID often must contend with similar community-level risk factors for HIV, such as incarceration, stigma, and economic vulnerability. "There is an urgent need to reach a consensus that programs and research for transgender women have lagged behind other key populations at risk for HIV," study authors concluded.