The Dutch meta-analysis, published December 1 in the journal PLoS One, reviewed data from 98 studies conducted in 34 countries and estimated HIV prevalence to be about 20 percent for transfeminine individuals and almost 3 percent for transmasculine individuals. The findings confirmed that transfeminine people have extremely high rates of HIV, and did so with more subjects and a broader geographic span than previous analyses. The investigation is also noteworthy for its findings about transgender men. “This is indeed the first meta-analysis to estimate the worldwide burden of HIV among transmasculine individuals,” says the lead researcher, Sarah E. Stutterheim, PhD, an assistant professor of health and social psychology at the University of Maastricht. Transgender men and other transgender people on the masculine end of the spectrum are not often part of the conversation around HIV, Dr. Stutterheim notes. Her research may help change the discussion.
Trans Communities in Latin America and Sub-Saharan Africa Are at Especially High Risk
The review analyzed studies published between January 2000 and January 2019 with data from Africa, Asia, Europe, Oceania, and the Americas. While most previous reviews looked at numbers from the United States, “these analyses show that trans individuals in Latin America and in sub-Saharan Africa are particularly vulnerable,” says Stutterheim. She and her team found that HIV prevalence rates for trans individuals in Latin America was 26 percent, and in sub-Saharan Africa it was 30 percent.
Healthcare Inequities Are Harming Trans People With HIV
Mallery Jenna Robinson, an advocate for transgender and HIV healthcare in Los Angeles, says that disproportionately high HIV rates in trans communities are due to lack of access to equitable healthcare. “Equitable healthcare includes creating safe medical spaces for trans women,” Robinson notes. “Since those spaces are limited, trans women — especially trans women of color — do not utilize healthcare spaces for testing or any other healthcare needs due to the stigma and discrimination.” U.S. public health initiatives targeting HIV prevention and culturally competent care for the transgender community have lagged behind efforts on behalf of other groups, Robinson argues. The first National Transgender HIV Testing Day was observed in 2016 — years after other HIV awareness days. It wasn’t until just four months ago that Tori Cooper became the first Black transgender woman ever to join the Presidential Advisory Council on HIV/AIDS. “We need to better tailor HIV prevention to the needs of trans individuals and make PrEP [pre-exposure prophylaxis] available for trans people,” says Stutterheim. “Also, we need to address structural factors that make trans folks more vulnerable, such as discrimination, judgment in healthcare settings, and lack of legal recognition.” Robinson agrees anti-transgender discrimination and stigma are key drivers of healthcare disparities: If a transgender woman is afraid to go to a clinic because she risks mistreatment, she won’t access testing or care. RELATED: 6 Ways to Gauge Whether Your Doctor’s Office Is Trans-Friendly Educating healthcare providers, who may have biases against trans individuals, is critical, Robinson says. “The best way to prevent stigma and discrimination is to embrace learning about communities that an individual doesn’t identity with,” she says. “Bring in members from that community to provide trainings to assure all staff is accurately and effectively trained in transgender healthcare.”
