HIV prevalence among transgender women (often called “ladyboys” in Thailand and parts of Southeast Asia) varies widely by country, but the global median is 9.2% across 34 reporting countries. In Thailand, where the term “ladyboy” is most commonly used, the official rate is lower at 2.2%. Both figures are dramatically higher than rates in the general population, and the gap is driven by a combination of biological vulnerability and social barriers to healthcare.
HIV Rates in Thailand
Thailand’s Department of Disease Control and UNAIDS both report an HIV prevalence of 2.2% among transgender women in the country as of 2022. With an estimated population of roughly 62,800 transgender women in Thailand, that translates to approximately 1,400 people living with HIV in this group. About 75.6% of transgender women with HIV in Thailand are aware of their status, and 75% are receiving antiretroviral treatment. Condom use sits at 79.5%.
One notable gap: only 34% of Thai transgender women are covered by HIV prevention programs. That means roughly two out of three are not regularly reached by outreach, testing services, or access to preventive medication. This coverage shortfall is a key reason public health officials view the 2.2% figure as potentially underreported and the population as still highly vulnerable.
Global Rates Are Significantly Higher
Outside Thailand, rates climb steeply. According to UNAIDS data from 2024, the global median HIV prevalence among transgender people is 9.2%, but the range is enormous. Some Pacific Island nations report 0%, while South Africa reports prevalence as high as 58%. Globally, transgender women face a risk of acquiring HIV that is 20 times higher than people in the general population.
That 20-fold difference is not explained by any single factor. It reflects a combination of biological risk (receptive anal intercourse carries a higher per-act transmission probability than most other forms of sexual contact), limited access to healthcare, economic marginalization, and the compounding effects of stigma that keep people from seeking testing or treatment in the first place.
What Drives the Elevated Risk
The CDC identifies several structural forces behind the disparity. Stigma, discrimination, poverty, and limited access to quality healthcare all influence outcomes and continue to drive inequities in HIV rates. These are not abstract concepts for many transgender women. Nearly one in five transgender people living with diagnosed HIV reports depression and anxiety, conditions that make it harder to keep medical appointments, stay on treatment, and maintain the viral suppression that prevents transmission.
Housing instability plays a significant role as well. People experiencing homelessness face serious obstacles to consistent HIV care, and transgender women are disproportionately affected by housing insecurity in many countries. HIV stigma itself is measurable: on a standardized 100-point scale, transgender people with HIV report a median stigma score of 30, reflecting ongoing concerns about disclosure, negative self-image, and perceived public attitudes.
Sex work is another factor. In Thailand and other Southeast Asian countries, a meaningful proportion of transgender women engage in sex work, which elevates exposure risk. A study published in The Lancet followed young Thai men and transgender women who sell sex in Bangkok and Pattaya and found that while daily preventive medication (PrEP) dramatically reduces HIV risk when taken consistently, real-world effectiveness is often limited by inadequate uptake, low persistence, and inconsistent adherence.
Prevention Medication and Testing Gaps
PrEP is highly effective at preventing HIV when taken daily, and uptake among study participants in Thailand has been encouraging. In one clinical study, about 75% of enrolled participants eventually started PrEP, and 85.9% of those who began within the first month were still taking it a year later. Those are strong numbers for a clinical trial setting, but they don’t reflect the broader population, where coverage of prevention programs remains low.
Testing frequency matters too. Clinical guidelines in Thailand recommend HIV testing every six months for transgender women and other high-risk groups, with earlier testing after known exposure. The fact that roughly one in four Thai transgender women with HIV does not yet know their status suggests that testing access or willingness remains a barrier. Awareness of one’s status is the critical first step: people who know they have HIV and receive treatment can achieve viral suppression, which effectively eliminates the risk of transmitting the virus to sexual partners.
Why the Numbers Vary So Much by Country
The enormous range in prevalence, from 0% to 58% depending on the country, reflects differences in healthcare infrastructure, legal protections, cultural attitudes, and the availability of prevention tools. Countries with universal healthcare, anti-discrimination laws, and well-funded outreach programs tend to report lower rates. Countries where transgender people face criminalization, violence, or exclusion from formal healthcare systems see rates that are many times higher.
Thailand occupies an interesting middle ground. The country is culturally more accepting of transgender women than many nations, and its healthcare system has invested in HIV prevention. Yet the 34% prevention program coverage rate shows that acceptance alone is not sufficient without the systems to deliver consistent care. The 2.2% prevalence figure is low by global standards for this population, but it still represents a rate roughly seven times higher than Thailand’s general adult HIV prevalence of about 0.3%.