Programs to reduce the high risk of HIV infection among transgender people are urgently needed—but efforts are hindered by a lack of accurate information on HIV prevalence, HIV incidence, and specific risk factors facing this key population. A special supplement to JAIDS: Journal of Acquired Immune Deficiency Syndromes presents essential information to meet the challenges of HIV prevention in the transgender population. The journal is published by Wolters Kluwer.
"The 'Transgender supplement' has been developed to fill critical gaps in information on the state of the HIV epidemic among transgender individuals, to discuss opportunities for culturally-tailored prevention interventions, and to inform the way forward in responding to the unique public health challenge in this often marginalized and underserved population," according to Guest Editors Kenneth Mayer of Fenway Health, Boston; Beatriz Grinsztejn of Fundação Oswaldo Cruz, Rio de Janeiro; and Wafaa M. El-Sadr of Columbia University, New York. The full contents of the special issue are freely available on the JAIDS website: www.jaids.com.
Experts seek to build evidence for effective HIV prevention in transgender people
Although transgender individuals account for less than one percent of the population, they have a "distinctively increased" burden of HIV disease. Recent estimates suggest that the worldwide prevalence of HIV among transgender women is 19 percent—with odds HIV close to 50 times higher than in non-transgender adults of reproductive age.
Historically, HIV researchers and public health officials have grouped transgender women in the category of "men who have sex with men" (MSM). But that overlooks the multi-level factors—sexual behaviors, social networks, and discrimination, among others—that may contribute to HIV risk in transgender women. Even less is known about HIV risk and risk factors among transgender men.
Knowledge gaps exist in other areas as well, including the effectiveness of pre-exposure prophylaxis (PrEP) using antiretroviral drugs to decrease HIV transmission. Social stigma and the threat of violence may prevent transgender people from accessing available testing, prevention, and treatment services. "Developing effective programs to reduce HIV in transgender individuals will require an in-depth understanding of the epidemiology of behaviors and risks with specific types of partners in the diverse cultures where transgender people live," according to Dr. Mayer and colleagues.
Building on a recent workshop sponsored by the HIV Prevention Trials Network (HPTN), the eight papers in the special issue frame the important issues in developing a more holistic approach to the engagement of HIV prevention interventions for transgender individuals. Topics include:
- A comprehensive analysis of data on the epidemiology of HIV in transgender people.
- Potential for interactions between antiretroviral drugs and hormone therapy used by some transgender individuals—a key factor in evaluating the use of PrEP.
- Initial data and research priorities on PrEP in transgender women.
- A "holistic framework" for understanding the health needs of transgender people.
- Behavioral approaches to improving HIV protection for transgender women.
Other papers address critical research considerations: developing effective and sensitive strategies for engaging transgender people in HIV clinical trials, statistical issues in studying this and other small population groups at high risk of HIV, and ethical considerations for research with transgender individuals.
The supplement will be highlighted at this year's 21st International AIDS Conference, to be held in Durban, South Africa, July 18 to 22. "This special issue is a ground-breaking synthesis of the state-of-the-art and an insightful roadmap to meet the urgent challenge of addressing an underserved 'key population' at the heart of the WHO 90-90-90 campaign for HIV in transgender populations," comments Dr. William A. Blattner, Co-Editor of JAIDS.