HIV Prevention among Transgender Populations: Knowledge Gaps and Evidence for Action

October 2017 - Combination Prevention

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Poteat, T., Malik, M., Scheim, A., Elliot, A. Current HIV/AIDS Reports (July 2017), 14: 141–152, doi: 100.1007/s11904-017-0360-1.

This literature review described available evidence on HIV prevention for transgender populations, who face elevated HIV risk due to a number of risk factors. Evidence is limited; the authors found 13 studies describing three types of interventions:

  • Behavioral (11 interventions): Includes group learning comprising lectures and role-playing to address individual and psychosocial risk factors. Eleven of the 13 interventions were behavioral.
  • Biomedical (one intervention): Includes pre-exposure prophylaxis, which has been found highly efficacious among transgender populations if adherence is good. However, adherence has been found to be low among transgender populations. Most studies have insufficient numbers of transgender participants to identify significant results. Treatment as prevention has been implemented targeting transgender women using community-based peer-led approaches, case management, motivational interviewing, incentives, and training to improve adherence.
  • Structural (one intervention): These interventions are more complex and expensive to implement. There are no outcome data available, but three small-scale projects are underway that strengthen the gender–affirming components of HIV services and provide case management, skills building, and legal and social assistance for transgender people.

Interventions and research should disaggregate data on transgender populations, develop interventions that include gender affirmation components, and prioritize HIV risk-drivers for transgender populations. Evidence-based interventions should also be adapted and evaluated, and future research should have relevance for transgender populations. 

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