Centering Trans Lives in HIV Care

Released: January 02, 2026

Jonathan 'Tanya' A. Laguing

Activity Information

Activity

Key Takeaways

Gender affirmation is foundational to effective HIV care for transgender people, including using the correct names and pronouns, and ensuring confidentiality.
HIV care should be delivered alongside gender-affirming care, comprehensive sexual healthcare, and mental health support, for a holistic, integrated approach to healthcare.

Anticipating and Addressing Key HIV Care Concerns for Transgender People
For healthcare professionals (HCPs), the first essential thing to do is to use the correct names and pronouns of all transgender and gender-diverse people. This is a quick and easy way to communicate right away that this clinic is an affirming environment that values diversity and inclusion.

I have observed a lack of transgender-competent HCPs in the Philippines, not just in HIV care, but generally speaking. One thing that would help is employing more transgender people in healthcare. I believe all health centers should have transgender staff. That would be much appreciated by our community. Transgender people are the best for providing transgender-competent care because we understand the community’s needs. I believe that it is much more comfortable for trans individuals to talk with someone who knows firsthand all the experiences they have been through. Ideally, a transgender care associate would be available for trans patients to oversee the entirety of their HIV care journey, from testing to prevention and even for monitoring.

Another key concern for transgender people with HIV is antiretroviral therapy (ART) vs hormone therapy. They often worry about possible interactions between gender-affirming hormone therapy (GAHT) and ART. Misinformation and lack of counseling about these topics often leads to poor adherence to HIV treatment. HCPs must be prepared to openly discuss these issues and design treatment plans to maintain both HIV suppression and gender affirmation.

Transgender people also face higher rates of mental health challenges, often related to gender dysphoria, experiences of stigma, and discrimination. This can cause not only anxiety, but depression and other mental health issues as well. So HCPs should be ready to provide mental health and gender-affirming counseling, or to help connect people to appropriate resources.

On a related note, maintaining privacy and confidentiality is of critical importance to many transgender people. Taking care not to disclose confidential information goes a long way towards building trust and supporting engagement with the healthcare system.

Establishing Integrated, Holistic Healthcare for Transgender Individuals
An integrated, holistic healthcare system is the ultimate goal for transgender individuals, where they can receive gender-affirming care, comprehensive sexual healthcare, and HIV care—including testing, PEP, and PrEP—without needing to go to multiple appointments and clinics. This means offering a wider range of services, such as voice therapy and dermatology care. These may not “normally” be considered part of HIV care, but are very important for transgender people, and should be included in holistic healthcare.

A peer navigator should also be available to assist people, to uncomplicate healthcare as much as possible, particularly for HIV awareness and testing. Beyond employing more trans people, HCPs must continue promoting gender sensitivity by integrating staff training on sexual orientation, gender identity and expression, and sexual characteristics. This training should be provided to all staff members, from small health centers to larger hospitals, including primary care.

Accomplishing this will require social contracting with national and local government offices. Transgender healthcare should be a core part of the healthcare services provided to all individuals, including gender-affirming care, GAHT initiation and monitoring, and preoperative and postoperative care for those undergoing gender-affirming surgeries. Counseling and psychosocial support for gender transitioning are also essential components of these services.

Reducing the Impact of Structural, Systemic, and Intersectional Barriers
From a policy perspective, we need strong social and legal support to facilitate equity for transgender people. Legal assistance for gender recognition is a top priority. In addition, employment and adult support programs are needed to ensure that the basic needs of transgender people are being met. Financial inaccessibility is a great barrier for transgender people in the Philippines, especially for trans youth. We need leadership and environmental training for future leaders, especially for the trans youth of today. We should also provide community centers that offer safe spaces, including drop-in services for any support they may need. Finally, antidiscrimination and human rights policies must be in place to ensure comprehensive legal support.

From a healthcare and research perspective, I believe there is a serious data gap for trans people in HIV research in the Philippines. Transgender people are often excluded or misclassified in HIV studies, and the current countrywide HIV/AIDS surveillance system is not inclusive of trans people at all. So, improved representation in research and in the HIV/AIDS and Antiretroviral Therapy Registry of the Philippines surveys would go a long way towards more effectively serving the transgender population.

On a smaller scale, HCPs can work towards reducing barriers to healthcare by practicing transgender-competent, culturally competent, and trauma-informed care, and by turning their clinics into safe spaces for transgender people. That includes avoiding assumptions about sexual behavior, displaying gender-diverse people on flyers and posters, providing condoms for free, and promoting sexual health education. Ultimately, it’s about maintaining respect for transgender people, staying knowledgeable about current issues for the trans community, and advocating for inclusive policies in the workplace, school, and even in public spaces.

I believe the right policy framework is to ensure inclusion for everyone and to normalize intersectionality.
Recognizing how intersectionality affects access to health outcomes is key to ensuring that transgender people stay engaged in not just HIV care, but healthcare overall.

Your Thoughts
What are some ways, big or small, that you practice transgender-competent care? Or, what changes do you plan on making to your practice based on this commentary? Leave a comment to join the discussion!

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