Recently enacted laws in North Carolina and Mississippi and their impact on the rights of the LGBTQ community have brought to light a serious public health issue: an increased risk of HIV and gender-based violence. Laws such as these, as well as in other states, specifically exclude communities from protections against discrimination and create environments with gender inequality, stigmatization, and differential access to services. Together, this can lead to increased risk of violence.

Discrimination against the LGBTQ community comes in many forms. Too often LGBTQ people face prejudice that makes it harder for them to get and keep a job. Due to economic instability, people in the transgender community, for example, may find that sex work is one of the few options they have to survive. This can lead to increased drug use and HIV.

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A few key facts reveal the severity of these matters:
  • Sex work puts transgender women at much greater risk of contracting HIV. Overall, transgender women are 49 times more likely to acquire HIV. More than 25 percent of transgender women who engage in sex work around the world are living with HIV.
  • Sex workers are also more likely to have substance abuse issues. For example, 20 to 30 percent of lesbian, gay, and transgender people experience substance abuse, compared with 9 percent of the general population.
  • Most alarming though is the gender-based violence. Between 2008 and 2015, 1,933 transgender people were murdered globally.

Additionally, women, transgender and gender nonconforming individuals are often dually stigmatized by the broader community and within the drug-using community, which can increase alcohol and other drug use. Stigmatization can also threaten access to healthcare services. Clinics have been known to turn away people with HIV, alleging to be unequipped to treat them. Regular treatment is crucial to keeping HIV a chronic condition rather than a death sentence, and after being turned away or stigmatized in a medical center, patients may get discouraged and stop seeking care.

The good news is we know how to address these problems. The bad news is it often takes up to 20 years to adopt these solutions on a broad scale. Consequently, gaining faster adoption of these solutions where gender inequality is most associated with HIV/AIDS requires greater political will and cooperation. Specifically, we need our political leaders to support scaling up evidence-based programs to address these problems, rather than legalize discrimination.

One example of a successful evidence-based HIV prevention intervention program is the Women's Health CoOp (WHC), which began in North Carolina. Supported by the National Institute on Drug Abuse, this program is designed to address the intersection of alcohol and drug use, and violence to reduce HIV. The WHC is founded on social cognitive theory and uses an empowerment framework – which seeks to enhance skills and increase self-efficacy. It focuses on mitigating the stressors women face, sexual assertiveness, and power imbalances in relationships.

Gender equality, especially in the LGBTQ community, is one of the top civil rights issues of our day, and we need our political leaders to act to prevent states from passing laws that specifically allow discrimination based on sexual orientation. Instead, Congress – as well as state and local governments – needs to rapidly incorporate evidence-based programs into the National HIV/AIDS Strategy and National Drug Control Strategy to combat HIV, alcohol and drug abuse, and gender-based violence.


Wendee M. Wechsberg is Director of the RTI Global Gender Center at RTI International.