Almost a fifth of transgender women worldwide
are infected with HIV, results of a meta-analysis published in The Lancet Infectious Diseases shows. A
total of 39 studies involving over 11,000 transgender women in 15 different
countries were included in the study, which also found that prevalence of HIV
among transgender women was massively higher than that seen in the general
“Our findings suggest that transgender
women are a very high burden population for HIV and are in urgent need of
prevention, treatment, and care services,” comment the authors.
For the purposes of the study, transgender
women were defined as individuals who were born as biological males but who
identified as women. A meta-analysis conducted in 2008 showed a very high
prevalence of HIV among transgender women in the United States, and a separate
meta-analysis found that transgender women engaged in sex work were
significantly more likely to be infected with HIV compared to male and other female
Little, however, is known about the overall
worldwide burden of HIV among transsexual women. A team of investigators
therefore conducted a systematic review and meta-anlaysis. They included all
studies conducted between 2000 and 2011 that reported on HIV prevalence among
transgender women compared to the general adult population.
A total of ten studies conducted in low- and
middle-income countries and five studies carried out in richer countries were
identified by the authors.
The pooled HIV prevalence for transgender
women was 19.1%. Among transgender women sampled in low- and middle-income
countries, the prevalence was 18%, compared to a prevalence of 22% in richer
Overall, transgender women were 49 times
more likely to be infected with HIV compared to adults in the general
population. This risk differed little between low- and middle-income countries
(OR = 50) and resource-rich countries (OR = 46).
All 15 countries contributing studies have
predominately male HIV epidemics.
The investigators established that, overall,
transgender women were 36 times more likely to have HIV compared to males in the
general populations of these countries. In addition, transgender women were some 78
times more likely to be infected with HIV compared to other women in the general
population. The magnitude of these risks were similar regardless of settings.
“The findings of the meta-analysis of HIV
infection rates are remarkable for the severity and consistency of disease
burdens across these populations,” write the investigators.
But why do transgender women have such a
high burden of HIV? The investigators believe that many of the infections will
have been acquired via unprotected anal sex; that transgender women are likely
to be involved in sexual networks where there is a high HIV prevalence; and
also that a significant proportion of transgender women engage in sex work. The
authors also note there “remains a dearth of research on HIV acquisition risks
from neovaginal intercourse after vaginoplasty”.
Stigma, discrimination and exclusion from
prevention, treatment and care services are also offered as possible
explanation. The authors emphasise that: “Few health-care workers, from HIV counselors
to nurses and physicians, have received any training on addressing the specific
health needs of transgender women.”
Data from the United States are also
highlighted by the authors showing an elevated HIV prevalence among transgender
They conclude, “present HIV surveillance and
prevention interventions for transgender women are clearly inadequate…the
findings of this meta-analysis make clear that urgency is needed to address this
severe and widespread component of worldwide HIV.”
The authors of an editorial in the same
edition of The Lancet Infectious Diseases
believe the research provides “a timely and important scientific reference and
responsible advocacy tool to promote the physical and mental health of
transgender women through appropriate services founded on scientific research”.