Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations

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.

Development of a telehealth intervention to promote care‐seeking among transgender women of color in Washington, DC

“…This study is the one of the first of its kind to assess the basic needs of a telehealth intervention and incorporate formative findings into the development of a telehealth program tailored for TWC. Our findings regarding Individual, Organizational, and Environmental barriers were consistent with findings from previous studies looking at health care engagement for the transgender population (Adelson et al, ; Ayala & Ibanez, ; Baral et al, ; Bradford et al, ; Brennan et al, ; Bry et al, ; Cicero et al, ; Eaton, Kalichman, et al, ; Eaton, Matthews, et al, ; Frank et al, ; Garofalo et al, ; Jin et al, ; Kussin‐Shoptaw et al, ; MacCarthy et al, ; Poteat et al, ; Reisner et al, ; Siembida et al, ) and are helpful in leveraging technology and telemedicine approaches to better serve TWC. Upon completion of the formative data collection, several day‐long meetings with study faculty and staff and key TWC stakeholders were convened to discuss the findings and propose the intervention, which was subsequently evaluated in a pre–post test pilot study (Magnus et al, ).…”

“…Environmental barriers were consistent with findings from previous studies looking at health care engagement for the transgender population (Adelson et al, 2016;Ayala & Ibanez, 2017;Baral et al, 2013;Bradford et al, 2013;Brennan et al, 2012;Bry et al, 2018;Cicero et al, 2019;Eaton, Kalichman, et al, 2017;Eaton, Matthews, et al, 2017;Frank et al, 2019;Garofalo et al, 2006;Jin et al, 2019;Kussin-Shoptaw et al, 2017;MacCarthy et al, 2017;Poteat et al, 2019;Reisner et al, 2016;Siembida et al, 2016) and…”

“…The transgender population is a medically underserved and largely understudied population with extensive barriers to health care. Significant stigma, violence, mental health disorders, elevated human immunodeficiency virus (HIV), sexually transmitted infections (STI), and comorbidities that are indicators of suboptimal health care have been well documented among transgender persons in general, and among transgender women of color (TWC) in particular (Adelson, Dowshen, Makadon, & Garofalo, ; Ayala & Ibanez, ; Baral et al, ; Bradford, Reisner, Honnold, & Xavier, ; Brennan et al, ; Bry, Mustanski, Garofalo, & Burns, ; Cicero, Reisner, Silva, Merwin, & Humphreys, ; Eaton, Kalichman, et al, ; Eaton, Matthews, et al, ; Frank et al, ; Garofalo, Deleon, Osmer, Doll, & Harper, ; Jin et al, ; Kussin‐Shoptaw, Fletcher, & Reback, ; MacCarthy et al, ; Poteat, Wirtz, & Reisner, ; Reisner et al, ; Siembida, Eaton, Maksut, Driffin, & Baldwin, ). TWC (for the purposes of this study, we considered TWC as transgender women who identify as African‐American, Native American, Latina, Asian Pacific Islander, and/or mixed race/ethnicity) often experience compounded risks to health care that may result from prejudices associated with gender identity, poverty, racism, and heterosexism and often result in structural barriers to care (Adelson et al, ; Eaton, Kalichman, et al, ; Eaton, Matthews, et al, ; Nuttbrock, ; Nuttbrock et al, ).…”

Epidemiology of gonorrhoea: a global perspective

“…Although data on gonorrhoea among transgender people are limited, transgender people bear a strikingly disproportionate burden of HIV. 66,68,69 Available data have highlighted several factors thought to contribute to heightened STI risk: societal transphobia, discrimination and experiences of abuse; lack of legal authorisation for gender-congruent identification; barriers to gender-affirming health care; poverty; mood disorders; internalised transphobia contributing to depression and substance abuse; and particularly germane to STI risk, difficulty finding employment with resulting engagement in sex work and transactional sex; and condomless receptive anal intercourse. 67,[69][70][71] A disproportionate incidence or prevalence of gonorrhoea is probable and worthy of exploration.…”

Caring for transgender people: looking beyond the hype

“…McNulty and Bourne, 10 and MacCarthy et al 11 remind us of the high prevalence of HIV and STIs in transgender individuals. Similar to the difficulties in estimating the prevalence of transgender children, the current research on HIV prevalence in transgender people is limited by sample biases and how to adequately define the population.…”