The Role of Gender in HIV Care Engagement Among Individuals Assigned Male Sex at Birth: Medical Monitoring Project, United States, 2015-2022.

Objectives. To estimate the number of US transgender women living with HIV and compare determinants of health between US transgender women and presumed cisgender men. Methods. We analyzed cross-sectional interview and medical record data (2015-2022) from the Medical Monitoring Project, a nationally representative sample of people living with HIV in the United States. Results. Weighted estimates suggest that 21 088 US transgender women are living with HIV. Across nearly every domain, transgender women reported greater barriers to care than did presumed cisgender men, including higher rates of hunger or food insecurity (34% vs 18%), unstable housing or homelessness (33% vs 18%), and lower rates of viral suppression (66% vs 74%). Conclusions. Transgender women living with HIV face greater and distinct barriers to wellness and care engagement across multiple domains than their cisgender male counterparts. Public Health Implications. Transgender identity is a critical factor in HIV-related health equity. Future research is urgently needed to understand how to support transgender women living with HIV in accessing the services they need to live healthy lives. (Am J Public Health. 2026;116(10):1621-1628. https://doi.org/10.2105/AJPH.2026.308497).