Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review

Abstract

Transgender populations in the United States have been impacted by the HIV/AIDS epidemic. This systematic review estimates the prevalence of HIV infection and risk behaviors of transgender persons. Comprehensive searches of the US-based HIV behavioral prevention literature identified 29 studies focusing on male-to-female (MTF) transgender women; five of these studies also reported data on female-to-male (FTM) transgender men. Using meta-analytic approaches, prevalence rates were estimated by synthesizing weighted means. Meta-analytic findings indicated that 27.7% (95% confidence interval [CI], 24.8-30.6%) of MTFs tested positive for HIV infection (four studies), while 11.8% (95% CI, 10.5-13.2%) of MTFs self-reported being HIV-seropositive (18 studies). Higher HIV infection rates were found among African-American MTFs regardless of assessment method (56.3% test result; 30.8% self-report). Large percentages of MTFs (range, 27-48%) reported engaging in risky behaviors (e.g., unprotected receptive anal intercourse, multiple casual partners, sex work). Prevalence rates of HIV and risk behaviors were low among FTMs. Contextual factors potentially related to increased HIV risk include mental health concerns, physical abuse, social isolation, economic marginalization, and unmet transgender-specific healthcare needs. Additional research is needed to explain the causes of HIV risk behavior of transgender persons. These findings should be considered when developing and adapting prevention interventions for transgender populations.

Life Skills: Evaluation of a Theory-Driven Behavioral HIV Prevention Intervention for Young Transgender Women

“…In fact, a recent meta-analysis by Herbst and colleagues from the Centers for Disease Control and Prevention (CDC) of 29 US studies on transgender women indicated that 27.7% tested positive for HIV infection (four studies), while 11.8% self-reported being HIV seropositive (18 studies). 1 African American transgender women reported higher HIV infection rates than other racial/ethnic groups, regardless of assessment method. 1 Sexual risk behaviors, such as unprotected anal intercourse, multiple casual partners, and sex work pose transgender women's primary risk for HIV acquisition.…”

“…1 African American transgender women reported higher HIV infection rates than other racial/ethnic groups, regardless of assessment method. 1 Sexual risk behaviors, such as unprotected anal intercourse, multiple casual partners, and sex work pose transgender women's primary risk for HIV acquisition. However, these behaviors are influenced by important contextual factors such as mental health concerns, interpersonal violence or abuse, social isolation, economic marginalization, and unmet healthcare needs.…”

A Mixed Methods Study of the Sexual Health Needs of New England Transmen Who Have Sex with Nontransgender Men

“…[1][2][3][4][5][6][7][8][9][10][11] However, the inclusion of transmen in studies of HIV sexual risk behavior remains uncommon. 1,2,4,[11][12][13][14][15] The current state of knowledge of HIV and STD risk among transgender men may be influenced by a common assumption that transmen only engage in sexual behavior with nontransgender women (i.e., presumed heterosexual orientation), and not with nontransgender men. However, transmen have diverse sexual identities, desires, and behaviors, including being attracted to and engaging in sexual behavior with nontransgender men, nontransgender women, and other transgender individuals, including transmen and transwomen.…”

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

“…8 A systematic review of research with transgender individuals found that male-to-female (MTF) transgender individuals reported high rates of both suicidal ideation (weighted mean, 53.8%) and lifetime suicide attempts (weighted mean, 31.4%). 17 Studies have explored the risk and protective factors associated with mental health problems among transgender women. In studies of transgender women, depression was associated with level of education and a self-reported history of sexual partner violence 7 as well as exposure to both verbal and physical abuse.…”