Stalled Progress in HIV Prevention for Trans Women in San Francisco: A Call for Upstream Solutions and Renewed...

We compare indicators of HIV prevention and care in two rounds of National HIV Behavioral Surveillance for transgender women (NHBS-Trans) in San Francisco. NHBS-Trans recruited 201 trans women in 2019/20 and 339 in 2023/2024 through peer referral methods. The proportion of trans women on ART significantly improved from 90% to 98% ([Formula: see text]=6.33, p = 0.018) over this time period. Additionally, methamphetamine use decreased overall from 32% to 22% (χ² = 7.08, p = 0.008). Among trans women living with HIV, the proportion reporting injection drug use also decreased from 22% to 11% (χ² = 3.98, p=0.046). HIV prevalence did not significantly change (42% in 2019/20 and 36% in 2023/24), nor did the proportion of participants reporting HIV testing (91% vs. 84%), condom use (45% vs. 48%), or PrEP use (43% vs. 40%). Notably, the proportions aware of their HIV status and virally suppressed remain below 90% in 2023/24, falling short of the > 95% targets set to end the HIV epidemic. Transgender women have consistently faced profound marginalization in the U.S. Stalled progress in addressing the HIV epidemic occurs in an era of increased politicization of transgender identity, cuts to HIV programs and research, and threats to the rights of transgender people in the United States. These efforts at erasure threaten progress in ending the HIV epidemic and risk creating structural, irreversible harm that no clinical innovation alone can overcome.