Introduction One of the biggest threats to the health of trans*females is HIV, particularly for those who are part of racial/minority groups. Yet health disparities for racial/ethnic minority trans*female youth remain understudied. Methods We examined baseline data from 282 trans*female youth ages 16–24 years old in the San Francisco Bay Area. We conducted Chi-squared tests for distributional differences between racial/ethnic minority and white participants in socio-demographic factors, HIV-related risk behaviors and syndemic factors. Results A total of 4.8% of trans*female youth were HIV positive. Racial/ethnic minority and white trans*female youth differed significantly in their gender identities and sexual orientations. Racial/minority youth also had significantly lower educational attainment, were less likely to live with their parents of origin as a child, and were significantly more likely to engage in recent condomless anal intercourse compared to whites. Conclusions Important disparities in HIV-related sexual risk behavior, education, and residential stability exist between racial/ethnic minority and white trans*female youth. Efforts to assess the impact of multiple minority stress for racial/minority trans*female youth are imminently needed. Additionally, macro-level disparities must be addressed in prevention efforts for trans*female youth, especially for those from racial/ethnic minority groups, in order to prevent incident cases of HIV and reduce disparities.

Research on the health of transwomen is largely focused on heterosexual HIV risk. Little is known about the health of sexual minority transwomen. We conducted a secondary cross-sectional analysis of data from a HIV risk and resilience study of transwomen aged 16 to 24 years in the San Francisco Bay Area (N=259). Prevalence and demographic characteristics of sexual minority transwomen was assessed and logistic regression models were used to examine the relationship between sexual minority status and alcohol and drug use. In logistic regression models, sexual minority transwomen had greater fold odds of heavy episodic drinking and illicit prescription drug use compared to their heterosexual counterparts, controlling for race/ethnicity, age, income, nativity, hormone status and history of feminization procedures. These results suggest that sexual minority status may be an important social determinant of health among gender minorities. Populations of transwomen are heterogeneous; effective interventions must consider sexual minority status.