Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations
Sarah MacCarthy A G , Tonia Poteat B , Zhiyu Xia B , Nicolette L. Roque C , Ashley (Hyun Jin) Kim D , Stefan Baral B and Sari L. Reisner E F
+ Author Affiliations
- Author Affiliations
A RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
B Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
C Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA.
D Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA.
E Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
F Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
G Corresponding author. Email: sarahm@rand.org
Sexual Health 14(5) 456-468 https://doi.org/10.1071/SH17096
Submitted: 16 May 2017 Accepted: 21 August 2017 Published: 13 October 2017
Abstract
Transgender populations are heavily burdened by HIV and other sexually transmissible infections (STIs). However, data on co-infection with HIV and STIs among transgender people are limited. A systematic review was conducted of peer-reviewed articles and conference abstracts between January 2010 and November 2015 that focussed on HIV and STI infections among transgender populations globally. The literature was synthesised and opportunities for improving health research were commented on. Few studies reported HIV–STI co-infection (n = 4), while the majority of studies reported HIV and STI infections separately (n = 23). Most studies were conducted outside of the USA (n = 19), and all but one of these studies reported data on transgender women only. Among USA-based studies (n = 8), several reported data on both transgender men and transgender women (n = 3), whereas other studies reported exclusively on transgender men (n = 1) or transgender women (n = 4). Understanding HIV and STIs among transgender people requires research that simultaneously considers multilevel drivers of vulnerabilities. More data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations. Leveraging the knowledge of transgender-specific determinants of HIV and STIs should guide the content and approaches to future HIV and STI prevention and treatment efforts.
Additional keywords: co-infection, STI.
References
[1] Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr 2016; 72 S210–9.| Global epidemiology of HIV infection and related syndemics affecting transgender people.Crossref | GoogleScholarGoogle Scholar |
[2] Poteat T, Wirtz AL, Radix A, Borquez A, Silva-Santisteban A, Deutsch MB, et al HIV risk and preventive interventions in transgender women sex workers. Lancet 2015; 385 274–86.
| HIV risk and preventive interventions in transgender women sex workers.Crossref | GoogleScholarGoogle Scholar |
[3] Baral S, Poteat T, Wirtz A, Stromdahl S, Beyrer C. Global burden of HIV infection among transgender persons: a systematic review and meta-analysis. J Int AIDS Soc 2012; 15 98–9.
[4] Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al Global health burden and needs of transgender populations: a review. Lancet 2016; 388 412–36.
| Global health burden and needs of transgender populations: a review.Crossref | GoogleScholarGoogle Scholar |
[5] Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13 214–22.
| Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[6] Centers for Disease Control and Prevention. HIV/AIDS & STDs. 2016 Available online at: https://http://www.cdc.gov/std/hiv/default.htm [verified May 2017].
[7] Reisner SL, Biello K, Rosenberger JG, Austin SB, Haneuse S, Perez-Brumer A, et al Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Arch Sex Behav 2014; 43 1503–14.
| Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain.Crossref | GoogleScholarGoogle Scholar |
[8] dos Ramos Farías MS, Garcia MN, Reynaga E, Romero M, Vaulet ML, Fermepin MR, et al First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence. Int J Infect Dis 2011; 15 e635–40.
| First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence.Crossref | GoogleScholarGoogle Scholar |
[9] Costa AB, Fontanari AM, Jacinto MM, da Silva DC, Lorencetti EK, da Rosa Filho HT, et al Population-based HIV prevalence and associated factors in male-to-female transsexuals from Southern Brazil. Arch Sex Behav 2015; 44 521–4.
| Population-based HIV prevalence and associated factors in male-to-female transsexuals from Southern Brazil.Crossref | GoogleScholarGoogle Scholar |
[10] Solomon MM, Nureña CR, Tanur JM, Montoya O, Grant RM, McConnell J. Transactional sex and prevalence of STIs: a cross-sectional study of MSM and transwomen screened for an HIV prevention trial. Int J STD AIDS 2015; 26 879–86.
| Transactional sex and prevalence of STIs: a cross-sectional study of MSM and transwomen screened for an HIV prevention trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28Xns1Gqu7c%3D&md5=a9ad9bb9cb34e57ce65bd7656acdeb80CAS |
[11] Lahuerta M, Sabido M, Giardina F, Hernandez G, Palacios JF, Ortiz R, et al Comparison of users of an HIV/syphilis screening community-based mobile van and traditional voluntary counselling and testing sites in Guatemala. Sex Transm Infect 2011; 87 136–40.
| Comparison of users of an HIV/syphilis screening community-based mobile van and traditional voluntary counselling and testing sites in Guatemala.Crossref | GoogleScholarGoogle Scholar |
[12] Aguayo N, Munoz SR, Aguilar G. P3.35 HIV and SYPHILIS prevalence and behaviour, practises and attitudes of the TRANS population in Paraguay, 2011. Sex Transm Infect 2013; 89 A254
| P3.35 HIV and SYPHILIS prevalence and behaviour, practises and attitudes of the TRANS population in Paraguay, 2011.Crossref | GoogleScholarGoogle Scholar |
[13] Silva-Santisteban A, Raymond HF, Salazar X, Villayzan J, Leon S, McFarland W, et al Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling. AIDS and Behavior 2012; 16 872–81.
| Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling.Crossref | GoogleScholarGoogle Scholar |
[14] Verre MC, Peinado J, Segura ER, Clark J, Gonzales P, Benites C, et al Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru. AIDS Behav 2014; 18 2030–9.
| Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru.Crossref | GoogleScholarGoogle Scholar |
[15] Castillo R, Konda KA, Leon SR, Silva-Santisteban A, Salazar X, Klausner JD, et al HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru. J Acquir Immune Defic Syndr 2015; 69 567–75.
| HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
[16] Sahastrabuddhe S, Gupta A, Stuart E, Godbole S, Ghate M, Sahay S, et al Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India. J Acquir Immune Defic Syndr 2012; 59 72–8.
| Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India.Crossref | GoogleScholarGoogle Scholar |
[17] Shrivastava SR, Bobhate PS. Prevalence of HIV and syphilis in patients attending sexually transmitted infections (STI) clinic in an Urban Slum. J Res Health Sci 2012; 12 7–14.
[18] Subramanian T, Ramakrishnan L, Aridoss S, Goswami P, Kanguswami B, Shajan M, et al Increasing condom use and declining STI prevalence in high-risk MSM and TGs: evaluation of a large-scale prevention program in Tamil Nadu, India. BMC Public Health 2013; 13 857
| Increasing condom use and declining STI prevalence in high-risk MSM and TGs: evaluation of a large-scale prevention program in Tamil Nadu, India.Crossref | GoogleScholarGoogle Scholar |
[19] Prabawanti C, Bollen L, Palupy R, Morineau G, Girault P, Mustikawati DE, et al HIV, sexually transmitted infections, and sexual risk behavior among transgenders in Indonesia. AIDS and Behavior 2011; 15 663–73.
| HIV, sexually transmitted infections, and sexual risk behavior among transgenders in Indonesia.Crossref | GoogleScholarGoogle Scholar |
[20] Kaplan RL, Wagner GJ, Nehme S, Aunon F, Khouri D, Mokhbat J. Forms of safety and their impact on health: an exploration of HIV/AIDS-related risk and resilience among trans women in Lebanon. Health Care Women Int 2015; 36 917–35.
| Forms of safety and their impact on health: an exploration of HIV/AIDS-related risk and resilience among trans women in Lebanon.Crossref | GoogleScholarGoogle Scholar |
[21] Shaw SY, Emmanuel F, Adrien A, Holte-Mckenzie M, Archibald CP, Sandstrom P, et al The descriptive epidemiology of male sex workers in Pakistan: a biological and behavioural examination. Sex Transm Infect 2011; 87 73–80.
| The descriptive epidemiology of male sex workers in Pakistan: a biological and behavioural examination.Crossref | GoogleScholarGoogle Scholar |
[22] Chariyalertsak S, Kosachunhanan N, Saokhieo P, Songsupa R, Wongthanee A, Chariyalertsak C, et al HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men, and transgender persons in Northern Thailand. PLoS One 2011; 6 e24295
| HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men, and transgender persons in Northern Thailand.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXht1ChsbzP&md5=5e11238ae815e8cde0fec0258d908061CAS |
[23] van Veen MG, Gotz HM, van Leeuwen PA, Prins M, van de Laar MJ. HIV and sexual risk behavior among commercial sex workers in the Netherlands. Arch Sex Behav 2010; 39 714–23.
| HIV and sexual risk behavior among commercial sex workers in the Netherlands.Crossref | GoogleScholarGoogle Scholar |
[24] Dias S, Gama A, Fuertes R, Mendão L, Barros H. Risk-taking behaviours and HIV infection among sex workers in Portugal: Results from a cross-sectional survey. Sex Transm Infect 2015; 91 346–52.
| Risk-taking behaviours and HIV infection among sex workers in Portugal: Results from a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[25] Turner R, Campbell M, Day S, Sullivan A. P2.164 High STI rates in a nurse delivered outreach service for sex workers-SWISH clinic. Sex Transm Infect 2013; 89 A138
| P2.164 High STI rates in a nurse delivered outreach service for sex workers-SWISH clinic.Crossref | GoogleScholarGoogle Scholar |
[26] Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS and Behavior 2011; 15 683–6.
| Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV.Crossref | GoogleScholarGoogle Scholar |
[27] Green N, Hoenigl M, Morris S, Little SJ. Risk behavior and sexually transmitted infections among transgender women and men undergoing community-based screening for acute and early HIV infection in San Diego. Medicine (Baltimore) 2015; 94 e1830
| Risk behavior and sexually transmitted infections among transgender women and men undergoing community-based screening for acute and early HIV infection in San Diego.Crossref | GoogleScholarGoogle Scholar |
[28] Reisner SL, Vetters R, White JM, Cohen EL, LeClerc M, Zaslow S, et al Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center. AIDS Care 2015; 27 1031–6.
| Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center.Crossref | GoogleScholarGoogle Scholar |
[29] Reisner SL, Perkovich B, Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men. AIDS Patient Care STDS 2010; 24 501–13.
| A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men.Crossref | GoogleScholarGoogle Scholar |
[30] Taylor RD, Bimbi DS, Joseph HA, Margolis AD, Parsons JT. Girlfriends: evaluation of an HIV-risk reduction intervention for adult transgender women. AIDS Education and Prevention 2011; 23 369–78.
[31] Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, et al Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health 2013; 103 300–7.
| Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study.Crossref | GoogleScholarGoogle Scholar |
[32] Operario D, Nemoto T, Iwamoto M, Moore T. Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women. AIDS and Behavior 2011; 15 674–82.
| Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women.Crossref | GoogleScholarGoogle Scholar |
[33] Nemoto T, Cruz TM, Iwamoto M, Sakata M. A tale of two cities: access to care and services among African-American transgender women in Oakland and San Francisco. LGBT Health 2015; 2 235–42.
| A tale of two cities: access to care and services among African-American transgender women in Oakland and San Francisco.Crossref | GoogleScholarGoogle Scholar |
[34] Reisner SL, White Hughto JM, Pardee D, Sevelius J. Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. International Journal of STD & AIDS 2016; 27 955–66. https://doi.org/10.1177/0956462415602418
[35] Nemoto T, Operario D, Keatley J. Health and social services for male-to-female transgender persons of color in San Francisco. International Journal of Transgenderism 2005; 8 5–19.
| Health and social services for male-to-female transgender persons of color in San Francisco.Crossref | GoogleScholarGoogle Scholar |
[36] Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, et al Gender abuse and incident HIV/STI among transgender women in New York City: buffering effect of involvement in a transgender community. AIDS & Behavior 2015; 19 1446–53.
| Gender abuse and incident HIV/STI among transgender women in New York City: buffering effect of involvement in a transgender community.Crossref | GoogleScholarGoogle Scholar |
[37] Reisner S, Keatley J, Baral S. Transgender community voices: a participatory population perspective. Lancet 2016; 388 327–30.
| Transgender community voices: a participatory population perspective.Crossref | GoogleScholarGoogle Scholar |
[38] Dourado I, Silva LA, Magno L, Lopes M, Cerqueira C, Prates A, et al Construindo pontes: a pratica da interdisciplinaridade. Estudo PopTrans: um estudo com travestis e mulheres transexuais em Salvador, Bahia, Brasil [Building bridges: interdisciplinarity in practice. PopTrans Study: a study with transvestites and transsexual women in Salvador, Bahia State, Brazil.] Cad Saude Publica 2016; 32 e00180415
| Construindo pontes: a pratica da interdisciplinaridade. Estudo PopTrans: um estudo com travestis e mulheres transexuais em Salvador, Bahia, Brasil [Building bridges: interdisciplinarity in practice. PopTrans Study: a study with transvestites and transsexual women in Salvador, Bahia State, Brazil.]Crossref | GoogleScholarGoogle Scholar |
[39] MacCarthy S, Reisner S, Hoffmann M, Perez-Brumer A, Silva-Santisteban A, Nunn A, et al Mind the gap: implementation challenges break the link between HIV/AIDS research and practice. Cad Saude Publica 2016; 32 e00047715
| Mind the gap: implementation challenges break the link between HIV/AIDS research and practice.Crossref | GoogleScholarGoogle Scholar |
[40] Grinsztejn B, Jalil EM, Monteiro L, Velasque L, Moreira RI, Garcia AC, et al Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV 2017; 4 e169–76.
| Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil.Crossref | GoogleScholarGoogle Scholar |
[41] Hwahng SJ, Nuttbrock L. Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City. J Homosex 2014; 61 691–713.
| Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City.Crossref | GoogleScholarGoogle Scholar |
[42] Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. Journal of Sex Research 2015; 52 243–56.
| Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity.Crossref | GoogleScholarGoogle Scholar |
[43] Reisner SL, Deutsch MB, Bhasin S, Bockting W, Brown GR, Feldman J, et al Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes 2016; 23 198–207.
| Advancing methods for US transgender health research.Crossref | GoogleScholarGoogle Scholar |
[44] Feldman J, Romine RS, Bockting WO. HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample. J Homosex 2014; 61 1558–88.
| HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample.Crossref | GoogleScholarGoogle Scholar |
[45] Reisner SL, Perez-Brumer AG, McLean SA, Lama JR, Silva-Santisteban A, Huerta L, et al Perceived barriers and facilitators to integrating HIV prevention and treatment with cross-sex hormone therapy for transgender women in Lima, Peru. AIDS Behav 2017;
| Perceived barriers and facilitators to integrating HIV prevention and treatment with cross-sex hormone therapy for transgender women in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
[46] Calabrese SK, Magnus M, Mayer K, Krakower D, Eldahan A, Hawkins L, et al “Support Your Client at the Space That They’re in”: HIV pre-exposure prophylaxis (PrEP) prescribers’ perspectives on PrEP-related risk compensation. AIDS Patient Care STDS 2017; 31 196–204.
| “Support Your Client at the Space That They’re in”: HIV pre-exposure prophylaxis (PrEP) prescribers’ perspectives on PrEP-related risk compensation.Crossref | GoogleScholarGoogle Scholar |
[47] Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, et al HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV 2015; 2 e512–9.
| HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial.Crossref | GoogleScholarGoogle Scholar |
[48] Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health 2016; 11 1060–75.
| ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women.Crossref | GoogleScholarGoogle Scholar |
[49] Global Network of Sex Works Projects. Community guide: HIV and STI testing and treatment policies. Edinburgh, Scotland: NSWP; 2016.
[50] Champredon D, Bellan S, Delva W, Hunt S, Shi C, Smieja M, et al The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis. BMC Infect Dis 2015; 15 249
| The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[51] Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al Transgender people: health at the margins of society. Lancet 2016; 388 390–400.
| Transgender people: health at the margins of society.Crossref | GoogleScholarGoogle Scholar |
[52] White Hughto JM, Murchison GR, Clark K, Pachankis JE, Reisner SL. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Health 2016; 3 424–433.
| Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis.Crossref | GoogleScholarGoogle Scholar |
[53] Perez-Brumer A, Hatzenbuehler ML, Oldenburg CE, Bockting W. Individual- and structural-level risk factors for suicide attempts among transgender adults. Behav Med 2015; 41 164–71.
| Individual- and structural-level risk factors for suicide attempts among transgender adults.Crossref | GoogleScholarGoogle Scholar |
[54] James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality; 2016.
[55] Ghoshal N, Knight K. Rights in transition: making legal recognition for transgender people a global priority. USA: Human Rights Watch; 2016.
[56] United Nations Human Rights Office of the High Commissioner. Discriminatory laws and practices and acts of violence against individuals based on their sexual orientation and gender identity. Report of the United Nations High Commissioner for Human Rights. Annual report. Geneva: Human Rights Council; 2011. Available online at: http://www.ohchr.org/Documents/Issues/Discrimination/A.HRC.19.41_English.pdf [verified 7 September 2017].
[57] Winter S, Settle E, Wylie K, Reisner S, Cabral M, Knudson G, et al Synergies in health and human rights: a call to action to improve transgender health. Lancet 2016; 388 318–21.
| Synergies in health and human rights: a call to action to improve transgender health.Crossref | GoogleScholarGoogle Scholar |
[58] Perez-Brumer AG, Reisner SL, McLean SA, Silva-Santisteban A, Huerta L, Mayer KH, et al Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru. J Int AIDS Soc 2017; 20 1–8.
| Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
