Language, cultural factors and fear of being deported are all key barriers.24 Around 1 million adults identify as transgender in the USA.
From 2009 to 2014, 2,351 transgender people were diagnosed with HIV in the country, the vast majority of whom (84%) were transgender women.
Although data remains limited, a 2013 study of 2,705 transgender women living in the USA found 22% were living with HIV.
Throughout 2017, the post of Director of National AIDS Policy, which exists to coordinate efforts to implement the National HIV/AIDS Strategy, has been vacant.
By the end of 2017, all members of the Presidential Advisory Council on HIV/AIDS (PACHA), which provides advice on the National HIV/AIDS Strategy, had either resigned or been fired.
Transgender people who took an HIV test in 2013 were 3 times more likely to have received a new HIV diagnosis than the rest of the population who tested.
More than half of the transgender people testing positive for HIV between 20 were African American/black (58% of transgender men and 51% of transgender women).25 The USA has the largest incarcerated population in the world, with 2.2 million people in prison or other closed settings.26 HIV prevalence is estimated to be 1.5% among prisoners, compared to 0.5% among the general population.