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The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

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  • Sarah E Stutterheim
  • Mart van Dijk
  • Haoyi Wang
  • Kai J Jonas

Abstract

Introduction: Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods: We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results: Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion: Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

Suggested Citation

  • Sarah E Stutterheim & Mart van Dijk & Haoyi Wang & Kai J Jonas, 2021. "The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-29, December.
    • Handle: RePEc:plo:pone00:0260063
    DOI: 10.1371/journal.pone.0260063
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    References listed on IDEAS

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    1. Hughto, J.M.W. & Reisner, S.L. & Mimiaga, M.J., 2015. "Characteristics of transgender residents of Massachusetts cities with high HIV prevalence," American Journal of Public Health, American Public Health Association, vol. 105(12), pages 14-18.
    2. Stefan Baral & Frangiscos Sifakis & Farley Cleghorn & Chris Beyrer, 2007. "Elevated Risk for HIV Infection among Men Who Have Sex with Men in Low- and Middle-Income Countries 2000–2006: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 4(12), pages 1-11, December.
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