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Huynh Jenny Descriptiveepipaper
Huynh Jenny Descriptiveepipaper
Jenny Huynh
Human Immunodeficiency Virus (HIV) is a problem that has continued to plague the
United States since its discovery in the late 1970s (Centers for Disease Control and Prevention
[CDC], 2017a). Once an individual acquires HIV, the virus never leaves the body and if left
untreated, it can develop into acquired immunodeficiency syndrome, or AIDS (CDC, 2017a).
HIV weakens the body’s immune system by attacking the T-cells (CDC, 2017a). This makes the
immune system unable to fight off infections, which as a result, makes the individual with HIV
more susceptible to infections or cancers related to infections (CDC, 2017a). The transgender
population in the United States is one of the more susceptible populations when it comes to
contracting the disease. According to the CDC (2017b), the number of new HIV diagnoses
amongst the transgender population is “three” times higher than the national average. The higher
than average diagnoses are due to many barriers that the transgender population faces, which will
be further discussed.
Mortality. In the United States alone, there were “6,721” HIV related deaths in 2014
(CDC, 2017c). This means that “2.1” people out of “100,000” pass away due to HIV and HIV
related complications (CDC, 2017c). Unfortunately, no data was found regarding HIV related
mortalities amongst the transgender population. This may be due in part to the fact that male-to-
female (MTF) transgender individuals are sometimes classified as men who have sex with men
(MSM) (San Francisco Aids Foundation [SFAF], 2009). With that being said, according to the
CDC (2017d), the mortality rates for MSM HIV related deaths were reported at “6,110”.
However, this number is not entirely reflective of the transgender population because not every
Morbidity. As aforementioned, the CDC (2017b) states that the amount of transgender
individuals diagnosed with HIV is “triple” that of other populations in the United States. From
2009 to 2014, there were “2,351” newly diagnosed cases of HIV amongst the transgender
population (CDC, 2017b). Of those “2,351” cases, “84” percent were transgender women, “15”
percent were transgender men, and the remaining identified as another gender (CDC, 2017b).
Transgender individuals living in the American south have the highest morbidity rates for HIV
(CDC, 2017b). Approximately “50” percent of the transgender men and women newly diagnosed
with HIV from 2009 and 2014 were from the American South (CDC, 2017b).
transgender individuals have a lower socioeconomic status and are more “vulnerable to
conditions of poverty” than their cisgender counterparts. Medicine used to treat HIV is fairly
expensive, and can place even more financial burden on these individuals. On average, monthly
HIV treatment ranges from “$2000” to “$5,000” (Aguirre, 2012). In addition, it estimated that an
HIV infected individual may spend upwards of “$500,000” in their lifetime (Aguirre, 2012).
Also, the CDC (2017e) reports that it will cost the United States approximately “$16.6 billion” in
lifetime HIV treatment costs. In addition, it is reported that the government’s spending on HIV
Agent of Disease
HIV is caused by a virus that attacks the CD4, or T-cells in the body (CDC, 2017a). T-
cells are white blood cells that the body uses to help fend off infections. Once a person becomes
infected with the virus, the number of CD4 cells in the body begin to diminish and the body is no
longer able to fight infections (CDC, 2017a). The structure of the HIV virus makes it extremely
easy for it to attack the CD4 cells in the body (Annenberg Learner, 2017). HIV is classified as a
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retrovirus, which means that once the viruses attaches itself to the host cell—in this case, the
CD4 cell—“the viral envelope fuses with the cell membrane, and the virus's RNA and enzymes
enter the cytoplasm,” (Annenberg Learner, 2017). Appendix A provides a visual representation
of the viral structure of HIV (Annenberg Learner, 2017). The enzyme reverse transcriptase
allows the RNA of HIV to be easily replicated, as well as makes it easier for its double-stranded
DNA structure to be generated (Annenberg Learner, 2017). From there, the enzyme integrase
allows the HIV virus to integrate itself into the T-cell’s cellular membrane (Annenberg Learner,
2017).
Clinical Symptoms
There are three stages of HIV: acute HIV infection, clinical latency, and AIDS (CDC,
2017a). In stage one, the individual usually exhibits flu like symptoms that may last “two to
four” weeks (CDC, 2017a). These symptoms include “chills, rash, night sweats, muscle aches,
sore throat, fatigue, swollen lymph nodes, and mouth ulcers,” (HIV, 2017b). During this stage,
individuals may not know that they have been infected with the virus, which is particularly
alarming due to the fact that during this time, the individual contains a large amount of the virus
in their blood and are considered to be highly infectious (CDC, 2017a). In stage two, also known
as the clinical latency stage, the virus is still active in the body, however it produces at much
lower levels (HIV, 2017b). The time an individual spends in stage two varies from person to
person, and depends on whether or not he or she is taking medication to help treat the disease
(HIV, 2017b). For instance, someone who is not actively taking antiviral therapy (ART) may be
in stage two for up to ten years (HIV, 2017b). On the other hand, those who are actively taking
ART to control the virus may spend many decades in this period before HIV progresses to AIDS
(HIV, 2017b). Finally, the last step is the progression into AIDS. Symptoms of AIDS may
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include “rapid weight loss, recurring fever or night sweats, extreme and unexplained tiredness,
and pneumonia,” (HIV, 2017b). In this stage, and individual’s immune system can no longer
fight off infections and are more susceptible to opportunistic illnesses (CDC, 2017a). If left
untreated, an individual may only live up to “three” years (CDC, 2017a). Appendix B provides a
visual representation of the different stages of HIV, based on the number of HIV versus CD4
Modes of Transmission
HIV is most commonly spread by having unprotected sex with an HIV positive person or
injected drug use (IDU) (HIV, 2017b). The virus is spread through bodily fluids such as blood,
semen, pre-seminal fluid, rectal fluid, vaginal fluid, and breast milk (HIV, 2017b). Contrary to
popular belief, HIV cannot be transmitted through tears, saliva, or sweat of an HIV positive
person (HIV, 2017b). Although uncommon, HIV can also be spread from mother to child during
childbirth (HIV, 2017b). Appendix C provides a visual of how an individual may contract AIDS
(Avert, 2017).
Mechanisms of Prevention
Primary. One of the most common ways that HIV is spread is through unprotected
sexual contact with an HIV positive person. Therefore, it is crucial for an individual to get tested
regularly for HIV and other STIs when engaging in sexual contact with a new partner. In
addition, it is important for the individual to know their partner’s sexual and testing history
(HIV, 2017b). As previously discussed, HIV is spread through bodily fluids such as seminal,
vaginal, and rectal fluids (2017b). Therefore, in order to protect oneself, an individual must wear
condoms when engaging in sexual intercourse. Another way to prevent the spread of HIV from
sexual intercourse is to take pre-exposure prophylaxis (PrEp) (HIV, 2017b). PrEp is a drug that
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is designed for individuals who do not have HIV, but are at risk for contracting HIV (HIV,
2017b). For instance, an individual who does not have HIV may take PrEp if their sexual partner
is infected (HIV, 2017b). Another primary prevention method is to not use injected drugs,
however if an individual does engage in IDU, it is imperative to sterilize equipment and to not
(2016), secondary HIV prevention is defined as “prevention activities directed toward people
who are HIV positive, with the intention of preventing transmission to those who are HIV
negative.” One secondary prevention method is to educate HIV positive patients on how they can
protect their sexual partners from the virus and how to limit the spread of disease to other people
(VA, 2016). Additionally, the VA (2016) aims to educate HIV positive patients on how to reduce
risky sexual behaviors and substance abuse. The VA (2016) also provides counseling to
Tertiary. The aim of tertiary prevention is to improve the quality of life of individuals
who have already been infected with HIV. One way to do this is to improve access to HIV
medications such as ART in order to prolong the transition from HIV to AIDS (Sahasrabuddhe
& Vermund, 2007). At times, many HIV positive patients feel ostracized from society, therefore
Sahasrabuddhe and Vermund (2007) suggest that they receive assistance for re-entering society
and the workforce as well as provide access to self-help groups. As for large-scale tertiary
prevention, Sahasrabuddhe and Vermund (2007) call for individuals to urge their legislators and
policymakers to make changes to health care so that it better serves the HIV positive and AIDS
field. Thus, it is also necessary to push policy makers to make changes to the way that healthcare
Host Factors
Gender. According to data collected by the CDC (2017b), transgender women have the
highest risk for contracting HIV. A large number of these transgender work in the sex industry,
which increases their risk of getting infected. According to Trans Equality (2016), “35.6” percent
of transgender individuals are involved in the sex work industry. Of those individuals, nearly half
of them are female (Trans Equality, 2016). Appendix D is a graph that shows the breakdown of
the number of transgender individuals in the sex industry, based on gender identity (Trans
Equality, 2016). Another factor that puts transgender women at a higher risk than transgender
males is that the majority of transgender women prefer anal sex (The Well Project, 2017). This
sexual position proves to be highly risky without protection because anal-penile intercourse tends
to leave tears in the anus, which allows the virus to enter the body (The Well Project, 2017). As
for women who have had sexual reconstructive surgery, their vaginas do not naturally lubricate
(The Well Project, 2017). With that being said, without proper lubrication the vaginal lining can
tear during intercourse, allowing HIV to enter the body (The Well Project, 2017).
Race. Data collected from the CDC (2017b) shows that African American transgender
individuals have a higher risk of contracting HIV than their white counterparts. “50” percent of
transgender individuals diagnosed with HIV are of African American descent (CDC, 2017b).
One reason for such a high prevalence of HIV amongst African American transgender
individuals is that they tend to have sexual relations within their race, which means “African
Americans face a greater risk of HIV infection with each new sexual encounter.” (CDC, 2017f).
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In general, African Americans also live in higher areas of poverty, which may limit their access
Geographic Location
“half” of the newly diagnosed cases of HIV amongst transgender individuals (CDC, 2017b). This
is due to the fact that there are higher levels of transphobia in the southern United States when
compared to other regions of the country (CDC, 2017g). Appendix E is a visual representation of
the risk of getting HIV in the southern region of the United States versus the other regions of the
United States (CDC, 2017h). Transphobia produces a negative stigma, which results in
transgender individuals being afraid to seek out testing or treatment of HIV (CDC, 2017g).
Transphobia in the South also limits the access to quality information about HIV; therefore
transgenders living are not knowledgeable on how to protect themselves and others (CDC,
2017g). Furthermore, the South has yet to adopt new HIV prevention and testing methods, which
prevents people from finding out their HIV status (CDC, 2017g).
Socioeconomic Factors
Socioeconomic factors influence many aspects of one’s life, including the chances of
contracting HIV. Transgender individuals have a lower socioeconomic status than people who
identify as straight. A reason for this is because employers refuse to hire these individuals due to
their gender identity (Fletcher, Kisler, & Reback, 2014). Due to the lack of stable and legal jobs,
transgenders, especially trans women, turn to the sex industry in search of an income (Fletcher,
Kisler, & Reback, 2014). In order to afford housing and other necessities, these transgender sex
workers engage in riskier and more dangerous sex acts in exchange for more money (Fletcher,
Kisler, & Reback, 2014). Due to their lack of a stable income, they are usually not able to afford
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hormone replacement therapy, and as a result, turn to illegal and “do it yourself” methods in
order to receive these hormones (Fletcher, Kisler, & Reback, 2014). The needles used to inject
these hormone treatments are not properly sanitized and are shared amongst multiple individuals,
therefore raising the risk of contracting HIV (Fletcher, Kisler, & Reback, 2014).
Temporal Variation
As of 2017, HIV is considered an epidemic in the United States (CDC, 2016). Although
the new number of diagnoses have declined since the 1980s, there are still “50,000” new total
cases in the United States each year (CDC, 2016). As a result of medical advances, there are
more people living with HIV than dying of HIV related illnesses (Kaiser Family Foundation,
2017).
Lack of Familial Support. Transgender individuals often face a lack of familial support
(CDC, 2017i). As a result, they are more likely to engage in risky behaviors, such as IDU in
order to cope with their situation (CDC, 2017i). Also, due to lack of familial support, many
young transgender individuals are not able to support themselves financially, which results in
them being involved in the sex industry, increasing their chances of getting HIV (Fletcher,
states of the United States, many HIV positive transgender individuals lack the quality health
care that they need (CDC, 2017g). Further studies by Reif, Wilson, and McAllaster (2014),
found that quality health clinics in certain areas of South Carolina are hard to come by.
Individuals often have to travel a great distance in order to have access to HIV care (Reif,
Wilson, & McAllaster, 2014). Once they reach their destination, they are faced with long wait
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times, even if they have an appointment (Reif, Wilson, & McAllaster, 2014). In addition, many
individuals also rely on public transportation in order to access these health care facilities,
however, the public transportation in South Carolina can at times be unreliable (Reif, Wilson, &
McAllaster, 2014).
Current Hypotheses
Currently, it is known that HIV is caused by a virus that is transmitted through sexual
contact with an HIV positive person and through bodily fluids such as blood, semen, and vaginal
fluids (HIV, 2017b). Furthermore, researchers know that transgender individuals are also at a
higher risk for contracting HIV due to risky sexual behaviors that are related to their occupation
(Trans Equality, 2016). Data also shows that the southern part of the United States has higher
rates of HIV due to stigma and lack of quality health care (CDC, 2017g).
Gaps in Knowledge
As previously discussed, there is very little data to be found regarding the mortality rates
of HIV infected individuals. According to the CDC (2017i), transgender men are the most
underrepresented and understudied group amongst the transgender population. The CDC (2017i)
states that further studies need to be made about the risky behaviors that put transgender men at
risk for HIV. Furthermore, physicians and other healthcare professionals still do not know how
to effectively treat transgender patients (CDC, 2017b). Physicians cannot successfully treat
transgender individuals if they do not understand how their post-gender reassignment surgeries
bodies work. In addition, the CDC (2017b) states that most HIV prevention programs are
originally made for cisgender individuals and are slightly modified to fit the needs of the
transgender population. However, this may pose a problem because a program that works for a
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cisgender population may not always translate successfully when applied to transgender
individuals.
subcategory. Many organizations are still putting transgender individuals in the gay or lesbian
category and that is not entirely representative of the transgender population (SFAF, 2009). Also,
more research needs to be done regarding the risk behaviors of transgender men in order to
reduce the prevalence of HIV within this subgroup. Although medicine exists to prolong life
expectancy and the transition into AIDS, there is currently no known cure for HIV. In order to
fully eradicate the HIV issue at hand, researchers need to be focused on finding a cure.
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References
Aguirre J.C. (2012). Cost of Treatment Still A Challenge For HIV Patients in the U.S..
Retrieved from:
https://www.npr.org/sections/health-shots/2012/07/27/157499134/cost-of-treatment-still
a-challenge-for-hiv-patients-in-u-s
https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/46/the-stages-of-hiv-infec
on
Annenberg Learner. (2017). The Structure and Life Cycle of HIV. Retrieved from:
https://www.learner.org/courses/biology/textbook/hiv/hiv_4.html
American Psychological Association. (2017). Lesbian, Gay Bisexual, and Transgender Persons
http://www.apa.org/pi/ses/resources/publications/lgbt.aspx
https://www.avert.org/hiv-transmission-prevention/how-you-get-hiv
Centers for Disease Control and Prevention. (2016). Today’s HIV/AIDS Epidemic. Retrieved
from:https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-todaysepidemic-508.
df
Centers for Disease Control and Prevention. (2017a). About HIV/AIDS. Retrieved from:
https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=6239&context=faculty_sch
larship
Centers for Disease Control and Prevention. (2017b). HIV Among Transgender People.
Running head: HIVAmongst Transgender Population in the United States in 2017 Huynh, 13
Centers for Disease Control and Prevention. (2017c). AIDS and HIV. Retrieved from:
https://www.cdc.gov/nchs/fastats/aids-hiv.htm
Centers for Disease Control and Prevention. (2017d). HIV Among Gay and Bisexual Men.
Centers for Disease Control and Prevention. (2017e). HIV Cost-effectiveness. Retrieved from:
https://www.cdc.gov/hiv/programresources/guidance/costeffectiveness/index.html
Centers for Disease Control and Prevention. (2017f). HIV Among African Americans. Retrieved
from: https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html
Centers for Disease Control and Prevention. (2017g). HIV in the Southern United States.
Retrieved from:https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf
Centers for Disease Control and Prevention. (2017h). HIV in the United States By Geographic
https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
Centers for Disease Control and Prevention. (2017i). HIV Among Transgender People. Retrieved
from:https://www.cdc.gov/hiv/pdf/group/gender/transgender/cdc-hiv-transgender-factsh
et.pdf
Fletcher, J. B., Kisler, K. A., & Reback, C. J. (2014). Housing Status and HIV Risk Behaviors
1651–1661.http://doi.org/10.1007/s10508-014-0368-1
https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv
Running head: HIVAmongst Transgender Population in the United States in 2017 Huynh, 14
Kaiser Family Foundation. (2017). The HIV/AIDS Epidemic in the United States: The Basics.
Retrieved from:
https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-
basics/
Reif, S.S., Wilson, E., & McAllaster C., (2014). HIV Infrastructure Study., Southern HIV/AIDS
https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=6239&context=faculty_sch
larship
Sahasrabuddhe, V. V., & Vermund, S. H. (2007). The Future of HIV Prevention: STI control and
http://doi.org/10.1016/j.idc.2007.03.005
San Francisco Aids Foundation. (2009). HIV Evidence Report. Retrieved from:
http://sfaf.org/policy-center/policy-library/sfaf-hiv-evidence-report-jan-2009-transgender
persons-and-hiv.pdf
from:http://www.transequality.org/sites/default/files/Meaningful%20Work-Full%20Rep
rt_FINAL_3.pdf
The Well Project. (2017). Transgender Women: HIV Prevention as a Priority. Retrieved from:
http://www.thewellproject.org/hiv-information/transgender-women-hiv-prevention-priori
United States Department of Veteran Affairs. (2016). Secondary HIV Prevention. Retrieved
from: https://www.hiv.va.gov/pdf/secondary-HIV-prevention.pdf
Running head: HIVAmongst Transgender Population in the United States in 2017 Huynh, 15
Appendix A
https://www.learner.org/courses/biology/textbook/hiv/hiv_4.html
Appendix B
https://aidsinfo.nih.gov/images/factsheet/HIVProgression800.jpg
Appendix C
https://www.avert.org/sites/default/files/styles/responsive_articlecustom_user_desktop_1x/public
/YOU_CAN_GET_HIV.png?itok=V1CdDMGP×tamp=1500022685
Appendix D
Trans Equality. (2016)’s Graph of Participation in the Sex Trade By Gender Identity
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http://www.transequality.org/sites/default/files/Meaningful%20Work-
Full%20Report_FINAL_3pdf
Appendix E
Centers for Disease Control and Prevention. (2017h)’s HIV in the United States By Geographic
Distribution
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https://www.cdc.gov/hiv/images/statistics/lifetime-risk-us-map-2014-900x512.png