Global health burden and needs of transgender populations: a review

Abstract

Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.

Copyright © 2016 Elsevier Ltd. All rights reserved.

Figures

Figure I.

Sexual and Reproductive Health Outcomes in Transgender Health Research (n=219 Data Points).+ +Author Note: Studies that reported HIV and STI data were coded in the “HIV” category. “STI-related” indicates studies reporting only on STIs.

Figure II.

Violence/Victimization in Transgender Health Research (n=105 Data Points).

Figure 1.

Map of the Distribution of Studies in Transgender Health (n=116).

Figure 2.

Number of Studies Containing Transgender Health and Disease Burden Per Year (n=116).

Figure 3.

Distribution of Studies By Assigned Sex at Birth in Transgender Health Research (n=116 studies)

Figure 4.

Distribution of Data Points Grouped Into Six Health-Related Outcome Categories in Global Transgender Health Research (n=981).