High and Stable Human Immunodeficiency Virus Prevalence Among Transwomen With Low Income Recruited With Respondent-driven Sampling, San Francisco, 2010-2016

Sex Transm Dis. 2019 Feb;46(2):118-124. doi: 10.1097/OLQ.0000000000000916.


Background: Studies have documented high human immunodeficiency virus (HIV) prevalence among transwomen in the United States; however, to our knowledge, no studies have documented trends in HIV prevalence in this population.

Methods: We used respondent-driven sampling to sample transwomen in San Francisco for 3 HIV prevalence and behavioral surveys in 2010, 2013, and 2016. Our analysis of point estimates and trends were weighted for the sampling method.

Results: Human immunodeficiency virus prevalence by serological testing in the survey was 38.8% (95% confidence interval [CI], 32.4-45.2), 33.7% (95% CI, 25.9-41.5), and 31.6% (95% CI, 12.2-38.1) in 2010, 2013, and 2016, respectively. Disparities in higher HIV prevalence by black, Latino, and Asian race/ethnicity and lower education level persisted through 2016.

Conclusions: Based on a statistical test for trend, HIV prevalence among transwomen has remained high and stable from 2010 to 2016. Human immunodeficiency virus infection is still highest at 31.6% compared to any other group in San Francisco. We also observed that older transwomen had significantly higher odds of living with HIV than younger women over the last 2 waves of data collection. Taken together, these trends suggest that there is declining incidence of new HIV infections among low-income transwomen in San Francisco. Moreover, among transwomen, HIV disproportionately affects transwomen of color.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Data Interpretation, Statistical
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Poverty*
  • Prevalence
  • Sampling Studies
  • San Francisco / epidemiology
  • Sexual Behavior
  • Sexual Partners
  • Surveys and Questionnaires
  • Transgender Persons / statistics & numerical data*
  • Young Adult