Authors
Stevens, Oliver; Anderson, Rebecca L.; Sabin, Keith; Garcia, Sonia Arias; Fearon, Elizabeth; Manda, Kingsley; Dikobe, Wame; Mulenga, Lloyd; Philip, Neena M.; Maheu-Giroux, Mathieu; Zhao, Jinkou; Mahy, Mary; Imai-Eaton, Jeffrey W.
Abstract
Introduction:
The Global AIDS Strategy 2021–2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalised and experience disproportionate risk of HIV infection in sub-Saharan Africa (SSA) and data to guide HIV programmes are severely limited. Surveillance data among cisgender men who have sex with men (cis-MSM) are comparatively abundant. We assessed whether HIV prevalence among cis-MSM was correlated with HIV prevalence among transgender women.
Methods:
Data from key population surveys conducted in SSA between 2010–2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both transgender women and cis-MSM populations were analysed with random effect meta-analysis to estimate the ratio of HIV prevalence among cis-MSM:transgender women.
Results:
Twenty-one studies were identified encompassing 8,476 transgender women and 24,102 cis-MSM. Median HIV prevalence among transgender women was 23.5% (interquartile range [IQR] 11.5–39.8%) and 16.2% (IQR 8.1–26.8%) among cis-MSM. HIV prevalence among transgender women was 50% higher than in cis-MSM (prevalence ratio 1.48 95CI 1.25–1.76). HIV prevalence among transgender women was highly correlated with year/province-matched HIV prevalence among cis-MSM (R2 = 0.60), but poorly correlated with year/province-matched total population HIV prevalence (R2 = 0.01).
Conclusion:
Transgender women experience a significantly greater HIV burden than cis-MSM in SSA, underscoring the need for HIV services addressing the disproportionate vulnerability experienced by transgender women. Further bio-behavioural surveys focused on determinants of HIV infection, treatment uptake, and risk behaviours among transgender people, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities.
