Human Immunodeficiency Virus and Trans Women: A Literature Review

Abstract

Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom. This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology. We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care. We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services. There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.

Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

“…Conversely, a USA study found gender-specific discrimination was associated with sexual risk behaviours, but not HIV testing among trans people 14. A literature review on trans women and HIV identified a lack of UK data and research,15 which is concerning considering trans people in England are twice as likely to be diagnosed with HIV at a late stage than cisgender people 16. Research into barriers and psychosocial factors affecting access to sexual healthcare and HIV testing for trans people is needed to inform health promotion.…”

‘Stay at home …’: exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK

“…We explored changes in sexual behaviour and use of SHS among cisgender men, transgender and gender-diverse people who have sex with men in the UK, during the UK COVID-19 response to understand service need. The paucity of evidence on sexual risk behaviours among transgender and gender-diverse people in the UK [10][11][12] underlines the importance of identifying the sexual health needs of these groups. 13 Previous research demonstrated the feasibility and acceptability of rapid risk assessment methods to enhance existing surveillance measures in response to public health incidents and outbreaks.…”

Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

“…Trans people and in particular trans women are a key population at increased risk of HIV acquisition, yet are severely underserved in the global response, including in HIV prevention and testing research [ 2 , 3 ]. There is also a lack of data on the sexual health needs of trans men and women in the UK, despite the fact that this group is more likely to be diagnosed with HIV late, less likely to attend sexual health clinics and less likely to test for HIV than cisgender men who have sex with men (MSM) [4] , [5] , [6] .…”