In the United States, HIV/AIDS is a health issue that we tend to associate with developing countries in Africa, Asia and Eastern Europe. The quiet truth is that American HIV infections have remained steady over the past decade, with sex, gender, and race/ethnic minority populations disproportionately affected by AIDS in the 21st century. A subgroup that appears to have one of the highest rates of HIV infection is characterized by a confluence of sex/gender/race/ethnic minority attributes, as well as low-income status. This subgroup comprises male-to-female transgender individuals (MTFs) who engage in street-based commercial sex work (prostitution) in urban centers such as Washington, DC. MTF as a gender and sex work as an employment are not standard categories on the US census, so we do not have the kind of nationwide population data that would be necessary to generate a representative epidemiological profile for this sub-group. However, CDC surveillance does tell us that men of color who sleep with men (MSM) have a growing rate of HIV infection around the country, and the MSM category is understood to include most MTFs who reveal their status to health workers. Also, studies in several cities suggest that HIV among MTF transgenders, and MTF sex workers in particular, may be at epidemic levels. In a 1999-2000 study of 188 MTF transgenders living in the Washington, DC area, thirty-two percent (32%) reported their positive HIV status (Xavier 2000). In a similar study in San Francisco, thirty-five percent (35%) of 392 MTF transgenders actually tested seropositive (Clements-Nolle et al. 2001). Studies with MTF sex workers, such as one with 55 participants conducted in Atlanta, have found over fifty percent (50%) of samples infected with HIV (Boles and Elifson 1994).

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