High HIV burden identified in transgender women

Baral S. Lancet Infect Dis. 2013;13:214-222.

  • February 26, 2013

Transgender women comprise a high burden population of HIV worldwide, according to data published in The Lancet Infectious Diseases.

Transgender women have been either excluded or ignored in most HIV surveillance systems around the world, resulting in a limited understanding of the burden of HIV among this group,” Stefan Baral, MD, MPH, director of the key populations programs in the Center for Public Health and Human Rights at Johns Hopkins School of Public Health, told Infectious Disease News. “However, where studied, transgender women carry among the highest burden of HIV of any population.”

Stefan Baral 

Stefan Baral

Baral and colleagues conducted a systematic review and meta-analysis of studies examining the HIV burden in transgender women. They compared the HIV burdens between transgender women and other adults in the country.

The analysis included data from 15 countries, all of which had male-predominant HIV epidemics. Worldwide, the HIV prevalence among 11,066 transgender women was 19.1% (95% CI, 17.4-20.7). In low-income and middle-income countries, the HIV prevalence among 7,197 transgender women was 17.7% (95% CI, 15.6-19.8). Among the 3,869 transgender women from high-income countries, the HIV prevalence was 21.6% (95% CI, 18.8-24.3).

Compared with all adults in the 15 countries, the OR of transgender women having HIV was 48.8 (95% CI, 21.2-76.3). This did not differ between high-income and low-income and middle-income countries.

“The results were surprising in terms of the magnitude of the increased odds — nearly 50 times — of transgender women having HIV compared to other adults of reproductive age,” Baral said. “These data should stimulate interest in characterizing the burden of HIV and associated risk factors for transgender women across the world. In addition, these data suggest that studies need to be developed for transgender women specifically, rather than accruing them as a subpopulation of men who have sex with men.”

Baral said the study results have raised interest in further characterizing the risk factors for HIV infection among these women, with a focus on higher order risk factors such as stigma limiting the uptake of services. In addition, the researchers want to characterize and evaluate appropriate combination HIV prevention approaches targeted to transgender women, including biomedical, behavioral and structural approaches.

Disclosure: Baral reports no relevant financial disclosures.