A systematic review of studies of HIV among transgender women suggests that the prevalence of HIV in the United States is 27.7% among all transgender women and 56.3% among black transgender women. Data also suggests high rates of HIV among transgender women globally. Bacterial STD prevalence varies among transgender women, but is based largely on convenience samples.
Providers caring for transgender women should have knowledge of their patients’ current anatomy and patterns of sexual behavior before counseling them about STD and HIV prevention. Most transgender women have not undergone genital affirmation surgery and may retain a functional penis; in this instance, they might engage in insertive oral, vaginal, or anal sex with men and women.