Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People

Tonia Poteat, Ayden Scheim, Jessica Xavier, Sari Reisner, Stefan Baral, Tonia Poteat, Ayden Scheim, Jessica Xavier, Sari Reisner, Stefan Baral

Abstract

Introduction: Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations.

Methods: A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations.

Results: Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations.

Discussion: Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.

Conflict of interest statement

This research has been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. A.S. was supported by Pierre Elliott Trudeau Foundation and Vanier Canada Graduate Scholarships. S.R. was partly supported by the National Institute of Mental Health of the National Institutes of Health under award number R34 MH104072. The content is solely the responsibility of the authors and does not represent the official views of the U.S. Department of Health and Human Services, the National Institutes of Health, or the Health Resources and Services Administration. The other authors have no funding or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Multilevel drivers of HIV risk among transgender populations.

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