Transgender persons are at high risk for human immunodeficiency virus (HIV) infection; in a recent analysis of the results of over nine million CDC funded HIV tests, transgender women* had the highest percentage of confirmed positive results (2.7%) of any gender category ( 1 ). Transgender men, † particularly those who have sex with cisgender § men, are also at high risk for infection ( 2 ). HIV testing is critical for detecting and treating persons who are infected and delivering preventive services to those who are uninfected. CDC recommends that persons at high risk for HIV infection be screened for HIV at least annually, although transgender persons are not specified in the current recommendations. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to describe HIV testing among transgender women and men and two cisgender comparison groups in 27 states and Guam. After adjusting for demographic characteristics, transgender women and men had a lower prevalence of ever testing and past year testing for HIV (35.6% and 31.6% ever, and 10.0% and 10.2% past year, respectively) compared with cisgender gay and bisexual men (61.8% ever and 21.6% past year) and instead reported testing at levels comparable to cisgender heterosexual men and women (35.2% ever, and 8.6% past year). This finding suggests that transgender women and men might not be sufficiently reached by current HIV testing measures. Tailoring HIV testing activities to overcome the unique barriers faced by transgender women and men might increase rates of testing among these populations. BRFSS is an annual, state-based, random-digit–dialed cellular and landline telephone survey of the noninstitutionalized U.S. adult population. ¶ Gender identity was uniformly assessed in an optional module used by 20 jurisdictions** in 2014 and 22 jurisdictions †† in 2015. Fourteen jurisdictions participated in the module during both years, six participated only in 2014, and eight participated only in 2015, for a total of 28. Jurisdiction-specific response rates ranged from 33.0% to 59.2% §§ and 34.4% to 57.6% ¶¶ in 2014 and 2015, respectively. Transgender respondents were defined as those who answered affirmative to the question if they considered themselves to be transgender. Those who answered affirmative were asked to identify as male-to-female (defined as transgender women in this report), female-to-male (defined as transgender men in this report), or gender nonconforming. Because of small sample size, responses from gender nonconforming persons (n = 272) were not included in this analysis. Pooled data collected in 2014 and 2015 were used to compare demographic characteristics and HIV testing among transgender and cisgender respondents. Cisgender men who reported sexual orientations of gay or bisexual represent a group at high risk for HIV infection ( 3 ). Cisgender men and women who reported an orientation of straight (hereafter referred to as cisgender heterosexual men and women) represent a group at lower risk for infection ( 4 ). The proportion of respondents who reported ever and past year HIV testing was calculated, and unadjusted prevalence ratios and 95% confidence intervals were estimated to identify characteristics associated with ever testing among transgender women and men. Multivariable logistic regression models compared self-reported prevalence of ever and past year testing among transgender women and men with cisgender gay and bisexual men while adjusting for characteristics associated with testing in univariate models (p<0.10). All estimates were weighted to account for the complex multistage sampling design; because only 14 of 28 jurisdictions participated in the optional module during both years of data collection, weights for these 14 jurisdictions were averaged across the 2-year period to account for varying levels of participation over time. Estimates with relative standard error ≥30% were not reported. During 2014–2015, 28 jurisdictions collected data on gender identity, resulting in a total sample of 732 transgender women, 451 transgender men, 3,798 cisgender gay and bisexual men, and 301,524 cisgender heterosexual men and women (Table 1). The unadjusted prevalence of ever testing for HIV was 37.5% among transgender women, 36.6% among transgender men, 66.2% among cisgender gay and bisexual men, and 35.2% among cisgender heterosexual men and women. The unadjusted prevalence of past year testing was 11.7% among transgender women, 12.4% among transgender men, 27.5% among cisgender gay and bisexual men, and 8.6% among cisgender heterosexual men and women. TABLE 1 Selected demographic characteristics and HIV testing behaviors among transgender and cisgender respondents* — Behavioral Risk Factor Surveillance System, 27 states and Guam, † 2014–2015 Characteristic Transgender women Transgender men Cisgender gay and bisexual men§ Cisgender heterosexual men and women¶ No. %** (95% CI) No. %** (95% CI) No. %** (95% CI) No. %** (95% CI) Total 732 100 — 451 100 (—) 3,798 100 (—) 301,524 100 (—) Race/Ethnicity White, non-Hispanic 527 60.6 (52.8–67.9) 309 49.2 (37.9–60.6) 2,929 67.1 (63.7–70.3) 242,370 71.1 (70.7–71.5) Black, non-Hispanic 67 13.3 (9.3–18.7) 43 11.4 (6.6–18.9) 233 11.8 (9.7–14.5) 21,166 12.0 (11.7–12.3) Hispanic or Latino 46 13.2 (8.1–21.0) 48 29.0 (18.6–42.2) 250 12.8 (10.2–15.8) 14,320 11.0 (10.7–11.4) Other, non-Hispanic 77 12.9 (7.9–20.2) 42 —†† 338 8.3 (6.9–10.1) 19,890 5.9 (5.7–6.1) Age group (yrs) 18–24 55 14.2 (9.9–19.8) 30 15.6 (8.7–26.4) 434 21.9 (19.0–25.1) 14,166 11.7 (11.4–12.0) 25–44 146 29.1 (22.3–37.0) 98 45.2 (33.7–57.2) 893 33.4 (30.5–36.5) 60,098 31.5 (31.1–31.9) 45–64 322 40.3 (33.6–47.4) 185 25.0 (18.3–33.1) 1,582 33.9 (31.2–36.7) 122,321 36.2 (35.9–36.6) ≥65 209 16.4 (12.6–21.1) 138 14.2 (10.0–19.8) 889 10.8 (9.5–12.3) 104,939 20.6 (20.4–20.8) Education
