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Best Practices in Gender Affirming HIV Care
The Power of Choice: 6 Best Practices for Gender-Affirming HIV Care

Released: September 06, 2024

Expiration: September 05, 2025

Michael K. Gibson
Michael K. Gibson, MD, PhD, FACP
Kritima Jemma Samitpol
Kritima Jemma Samitpol,
Steven Christopher Smith
Steven Christopher Smith, MD, PhD
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Key Takeaways
  • When caring for transgender people living with HIV, services should be tailored to their needs (eg, gender-affirming care, sexually transmitted infection services, mental health support, social services).
  • Creating a safe and welcoming environment that ensures gender and culture sensitivity is key to providing person-centered care while enhancing health outcomes and building trust with individuals in the community.

If you are caring for transgender people living with HIV, the first thing you should ask yourself is, “How can I offer friendly services?” I think the only way to do this is to offer choices; the more choices you can offer, the more likely you will make people feel safe and welcome and ensure they do not fall out of care.

Here are 6 best practices that expand people’s choices that you should consider incorporating into your practice.  

1) Adopt an HIV Status–Neutral Approach
In a status-neutral approach, services focus equally on both HIV prevention and treatment. This approach ensures that all transgender individuals—regardless of their HIV status—receive the care they need. Prevention efforts, such as pre-exposure prophylaxis, should be available for transgender individuals without HIV. This approach helps to normalize HIV care, reduce stigma, and encourage more transgender individuals to seek and remain in care. 

2) Integrate Gender-Affirming Care With HIV and STI Services
Gender-affirming care should be seamlessly integrated with HIV and sexually transmitted infection (STI) services, as these are basic, essential healthcare needs for most transgender people that are inherently interconnected. Colocating these services in one facility ensures that transgender individuals can access comprehensive care in a single visit and reduce barriers often faced when navigating separate healthcare systems.

Same-day HIV and STI treatment should be offered to everyone. Delays in treatment because of inefficiencies with scheduling appointments or referrals can add to the barriers already faced by transgender individuals. With same-day services, healthcare professionals (HCPs) can help reduce the risk of complications while supporting the overall well-being of their patients. This approach also reinforces the message that their health is a priority, and that prompt care is available and accessible.

3) Address Concerns About Drug–Drug Interactions
One of the main concerns for transgender people regarding HIV care, whether for prevention or treatment, is the potential for drug–drug interactions between HIV medications and gender-affirming hormone therapy. A lack of information can lead to anxiety and hesitation in seeking care. That is why it is vital to provide clear, accurate information that HIV prevention and treatment medications can be safely used with gender-affirming hormone therapy under the supervision of HCPs.

4) Provide People-Centered Services
People-centered services are those that prioritize individual needs and consider the experiences of the specific patient. In the context of transgender healthcare, this means offering services that are not only medically appropriate but also culturally sensitive to and suitable for the social realities of transgender people. People-centered care supports the person’s whole well-being—respecting their identity and affirming their experiences.

Gender-affirming HIV care should involve tailored services to meet the specific needs of transgender individuals. Recognizing that transgender people may have different health priorities, including mental health support and social services, is crucial.

Offering peer support and counseling services alongside medical care can help address the unique challenges that transgender people face, thus improving their overall health outcomes. Such services should also be youth-friendly and accessible to individuals within the transgender community with diverse backgrounds and intersectionalities, including marginalized groups such as sex workers, refugees, and others facing multiple layers of discrimination.

In addition, U=U (undetectable = untransmittable) should be emphasized so that people receiving HIV treatment know they can be in a sexual relationship or have a family with zero risk of passing HIV to their partner if they are undetectable.

5) Engage the Transgender Community in Care Planning
When the transgender community is actively involved in the planning and delivery of HIV care, it increases the relevance and effectiveness of care and fosters a sense of ownership and trust in the healthcare system. The transgender community should be consulted with and engaged in the design of care models, ensuring that services are tailored to their needs and preferences. This can include hiring transgender staff members and creating advisory boards and feedback mechanisms that allow for continuous improvement of services.

6) Ensure Gender-Sensitive Care by All Staff Members
Finally, to create a welcoming and respectful environment, all staff who interact with transgender individuals should undergo comprehensive gender sensitization training. This training should focus on developing the right attitudes and ensuring that staff understand how to communicate effectively and respectfully with transgender people.

A stigma-free and discrimination-free environment begins with staff who are well-informed and respectful of gender diversity. In addition, the healthcare setting itself should be welcoming, with inclusive electronic health records that prevent misgendering and inclusive facilities such as all-gender restrooms.

Best practices in gender-affirming HIV care involve not only integrating essential services but also ensuring that care is timely, tailored to individual needs, and inclusive of all transgender people—regardless of their background or circumstances. By implementing these practices, HCPs can improve access to care, enhance health outcomes, and build trust with individuals in transgender communities. It is through these efforts that we can move closer to achieving equitable healthcare for all.

Your Thoughts?
What services do you offer to improve care for transgender people living with HIV? Join the discussion by posting a comment.