December 1st is World AIDS day! Since 1988, this observance has raised awareness about AIDS and the virus (HIV) that causes it while also creating space to memorialize loved ones who have died from AIDS-related illnesses. While great advancements have been made to prevent and treat HIV over the last 37 years, there is still a long way to go and a number of inequalities in HIV related care; an estimated 1.2 Million people in the US have HIV, 40% of whom are Black (KFF, 2024). HIV is also more likely to affect trans and gender diverse (TGD) people than cisgender people. Worldwide, the odds of a transgender woman getting HIV is 66 times higher than the general population (Stutterheim et al., 2021).
However, HIV research and advocacy has historically sidelined people AFAB and excluded trans men from research. A 2021 meta-analysis, shows that 96 studies (n=48,604) looked at HIV risk among trans women, compared to just 20 studies (n=6,460) that included trans men. While more inclusive research is needed, scientists currently estimate the odds of a trans masculine person getting HIV are almost 7 times higher than the general population (Stutterheim et al., 2021). Some medications used to prevent HIV are not technically approved for people AFAB because their manufacturers haven’t proven they are as effective at preventing HIV through vaginal sex as anal sex. Despite these barriers and gaps in knowledge, understanding their risks and prevention options is important for all trans men and nonbinary people who were AFAB.
What is HIV?
The Human Immunodeficiency Virus (HIV) is an infection that attacks the body’s immune system. HIV is spread through contact with an infected person’s bodily fluids, including blood, semen (cum), vaginal fluids, and breast milk. Most cases are related to sexual contact or sharing injection materials with a person who has HIV. While there is currently no cure for HIV, there are several medications to prevent and manage it.
Two to four weeks after they get the virus, some people may have symptoms like a fever or chills, swollen lymph nodes, muscle aches, and tiredness. Among people assigned female at birth, including trans men and transmasculine people, symptoms also include severe vaginal yeast infections that keep coming back, and changes to the menstrual cycle (heavier periods OR missed periods) (AIDS Healthcare Foundation, n.d.). However, some people never have symptoms. The only way to know for sure if you have HIV is to get tested.
What is AIDS?
Acquired Immunodeficiency Syndrome (AIDS) is the most severe stage of HIV infection. Without treatment, HIV breaks down the immune system and leads to AIDS around 8-10 years after infection. People with compromised immune systems may have a hard time getting over common, minor illnesses, like a cold. Illnesses that are caused by a weakened immune system are called opportunistic infections. Opportunistic infections are one of the biggest health risks to people with AIDS. While not the case in the US, the leading cause of death for HIV+ people globally is tuberculosis (TB) which claimed the lives of over 161,000 HIV+ people in 2023 (WHO, 2024).
Preventing HIV
Most people with HIV never have symptoms. This means routine testing is critical for protecting your health and the health of your partners. Men who have sex with men, including gay and bisexual trans men, should get tested every 3-6 months. Other sexually active adults may be able to get tested as infrequently as once a year. Regardless of gender identity, sex assigned at birth, or sexual orientation, talking to your doctor about your unique risk factors and behavior is the best way to figure out a testing schedule and prevention methods for you.
Most HIV screening tests use a mouth swab or finger prick to look for signs of HIV in your blood or saliva. You can often get results in as few as 20 minutes. If this test is positive, or shows signs of HIV infection, your doctor will order more tests and draw blood from a vein to confirm the results before diagnosing you with HIV (Cleveland Clinic, 2022). If you test positive for HIV, starting treatment is important for your health and to prevent spreading it to other people.
Because HIV is usually spread through sexual contact, using condoms every time you have sex is one of the easiest ways to prevent it. Internal condoms and traditional external condoms are both effective at preventing HIV and other STI’s, as long as they’re used correctly. There is also a high risk of getting HIV if you use drugs through injection. If you’re at risk from injection drug use, it’s important not to share or reuse injection materials (works) like needles, syringes, cookers, or filters. Make sure to dispose of any used needles in a secure, puncture proof sharps container.
Pre-Exposure Prophylaxis (PrEP) is a group of medications people without HIV can take to prevent getting it. The medication works by stopping the virus from copying itself and growing. If you take PrEP and are exposed to the virus, you are much less likely to get it; PrEP reduces the risk of getting HIV from sex by 99% and from injection drug use by at least 47% (National Institutes of Health, 2025). PrEP is currently available as a pill you take everyday or a shot you get at the doctors office every 2 months. There are several brands of PrEP, but it’s important to discuss your sexual behavior and which medications are most effective for preventing HIV spread through vaginal or anal sex with your doctor. Your doctor will talk through the risks and benefits of each medication and help you decide what’s best for you.
Post-exposure Prophylaxis (PEP) is another medication that can be used to prevent HIV in emergency situations. For example if someone is sexually assaulted or accidentally stuck with a used needle, PEP can reduce the risk of getting HIV by more than 80% (National Institutes of Health, 2025). However, PEP needs to be started within 72 hours (3 days) of the potential exposure to HIV to work. The sooner you take it, the more likely PEP is to prevent HIV. PEP isn’t supposed to be used often; if someone is frequently exposed to HIV, PrEP might be a better fit for their needs.
Neither PrEP or PEP are known to interact with HRT. Taking either medication won’t make your hormones work worse or more slowly. HRT also doesn’t make PrEP less effective at preventing HIV. While taking testosterone, some trans masculine people may experience vaginal dryness or atrophy (when the vaginal canal gets smaller). Vaginal atrophy can make it more likely to get small cuts or tears inside the vaginal canal during sex. These tears can give HIV direct access to your bloodstream, making the risk of getting HIV higher. This is one of the reasons PrEP and other prevention methods are important for trans masculine people. If you have pain or bleeding during sex or have a hard time getting or staying wet, using lube can help. Your doctor may also have other suggestions if you discuss it with them.
Conclusion
While HIV can seem like a dark cloud over the trans community, there are things we can do to protect ourselves and our loved ones. Particularly for trans people assigned female at birth, including trans men and nonbinary people, more research, education, and support is needed to address inequities in the response to HIV. Routine HIV testing is the only way to know if you have it. Using condoms is vital. PrEP and PEP are powerful HIV prevention medications used in different situations. The resources below include several Charlotte area organizations working to free our community from HIV.
Resources
- RAIN Inc. and their drop in testing center, The Drop
- Queen City Harm Reduction
- Amity Medical Group
- RAO Community Health
- Dudlely’s Place
- Planned Parenthood Charlotte
References
AIDS Healthcare Foundation. (n.d.). What is HIV? HIV Care. Retrieved November 19, 2025, from https://hivcare.org/hiv-basics/
KFF. (2024, August 16). The HIV/AIDS Epidemic in the United States: The Basics. KFF. https://www.kff.org/hiv-aids/the-hiv-aids-epidemic-in-the-united-states-the-basics/
National Institutes of Health. (2025, March 31). Post-Exposure Prophylaxis (PEP) | NIH. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/post-exposure-prophylaxis-pep
Stutterheim, S. E., Dijk, M. van, Wang, H., & Jonas, K. J. (2021). The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLOS ONE, 16(12), e0260063. https://doi.org/10.1371/journal.pone.0260063
World Health Organization. (n.d.). Global tuberculosis report 2024. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024