There are multiple factors that contribute to this. Transphobia, homophobia, and HIV stigma contribute to high rates of denial, secrecy, and depression. This, in turn, increases the risk of substance or alcohol abuse and risk-taking behaviors. Black people also experience higher rates of criminalization and homelessness in comparison to the general population. These factors are additive and result in a higher likelihood of testing positive for HIV in one’s lifetime. The extreme vulnerability of rectal tissues and smaller gay and trans sexual networks due to the reasons stated above also contribute.