Global scoping review of HIV prevention research with transgender people: Transcending from trans‐subsumed to trans‐centred research

Abstract

Introduction: Globally, transgender populations are disproportionally impacted by HIV and effective HIV prevention interventions targeting these populations are critically needed. Such interventions require research focused on the specific needs and experiences of transgender people. This methodological review aims to determine the extent to which HIV prevention research has included transgender participants by subsuming them into non-transgender populations, or by centring them either in comparison with other groups or as the sole focus of research. Methods: We searched five electronic databases (e.g. SCOPUS) for empirical studies that focused on HIV prevention and included transgender participants, published through 31 December 2020. For each study, we extracted information on: (a) types of inclusion of transgender participants; (b) total sample size and number/percentage of transgender participants; (c) country(ies) where study was conducted; (d) HIV research topics; (e) methods (i.e. quantitative, qualitative or mixed-methods research) and (f) gender identity of transgender participants. Results and discussion: Of 667 HIV prevention studies included in the review, 38.5% subsumed transgender participants into cisgender populations (most frequently combining transgender women with cisgender men who have sex with men), 20.4% compared transgender and cisgender participants and 41.1% focused exclusively on transgender populations. Our global scoping review also revealed that these three types of transgender inclusion in HIV prevention research vary greatly over time, place and thematic areas. Transgender women are the focus of the majority of reviewed studies, whereas transgender men and gender expansive people are rarely included as participants. Conclusions: Inclusion of transgender persons as participants in HIV prevention research has significantly increased, particularly in the last decade. Further research centred on transgender participants and their experiences are needed to develop effective HIV prevention interventions for transgender populations. We advocate for HIV prevention research to move from subsuming transgender people, to trans-centred research that asks questions that focus on their specific needs and experiences. We provide recommendations to move from trans-subsumed to trans-centred HIV prevention research.

Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

“…The vulnerability of TGW to HIV makes their use of PrEP of vital importance [ 27 , 28 , 29 ]. However, few TGW have been engaged in HIV prevention services [ 5 , 30 ] or PrEP studies [ 31 ], hindering the possibility of meaningful analysis [ 32 ], despite high willingness to use PrEP [ 33 , 34 , 35 ]. In addition, PrEP studies have shown low PrEP continuation among TGW [ 36 ].…”

Ethical HIV research with transgender and non‐binary communities in the United States

“…The first concern is the extent to which trans‐HIV research has emphasized descriptive documentation of risk, pathology and “vulnerabilities” among TGNBCs associated with potential HIV exposure, including sex work, lack of employment opportunities, housing instability, incarceration, violence, substance use and depression [ 7 , 11 , 13 , 17 , 25 , 26 ]. On the one hand, this focus has enabled a greater understanding of several acute challenges faced by TGNBCs, and some findings have been used as essential advocacy tools.…”

“…The fifth concern is the under-representation or tokenization of TGNBCs at all levels of the research process [7,15,[20][21][22]. In the current landscape of HIV research, cisgender researchers receive much of the funding for transgender research [15].…”

“…This research has documented how multiple intersecting structural factors, including racism, sexism, transphobia, homophobia and other systems of oppression, contribute to the disproportionately high rates of HIV infection among this population [9][10][11][12][13][14]. However, the proliferation of transgender HIV research has brought signifi-cant scientific and ethical concerns about research practices that may erase, alienate, objectify, exploit or re-traumatize the communities they are designed to benefit [7,13,[15][16][17][18]. A growing number of voices within the transgender and non-binary communities (TGNBCs) have begun to openly challenge the scientific rigour, public health benefit, ethical principles and research practice within transfocused HIV science by advocating for systemic change that prioritizes, promotes and sustains meaningful trans leadership and engagement at all levels of the research process [15,[19][20][21][22][23][24].…”

“…Over the past two decades, transgender individuals, particularly African American/Black and Latinx/Hispanic transgender women, have received increasing attention in HIV research [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. This research has documented how multiple intersecting structural factors, including racism, sexism, transphobia, homophobia and other systems of oppression, contribute to the disproportionately high rates of HIV infection among this population [ 9 , 10 , 11 , 12 , 13 , 14 ].…”