This scoping review sought to synthesize human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, incidence, risk behaviors, and risk perceptions among transmasculine (TM) individuals globally.
Methods:
Eligible articles were peer-reviewed observational and interventional studies published in English between August 2, 2014 and November 2, 2021. Four electronic databases were systematically searched: PubMed, Embase, PsycInfo, and Sociological Abstracts and reference lists hand-searched. Results are presented using numerical summary and thematic analysis.
Results:
Studies meeting inclusion criteria (n=39) spanned 12 countries and 2 multi-region studies. Laboratory-confirmed HIV prevalence ranged from 0% to 4% and self-reported HIV prevalence from 0% to 8%. Laboratory-confirmed STI diagnoses ranged from 1.2% to 7.7% for chlamydia, 0% to 10.5% for gonorrhea, 0% to 6% for syphilis, 1% to 8% for hepatitis C, and 0% to 8% for hepatitis B. Self-reported lifetime diagnosis of any STI ranged from 5.8% to 53.7%. No studies assessed HIV or STI incidence. Lifetime HIV testing prevalence varied from 23% to 89%. Lifetime STI testing prevalence ranged from 31.1% to 70.8%. Pre- and post-exposure prophylaxis use and knowledge were assessed in seven studies. Qualitative studies addressed HIV vulnerabilities and protective factors, including stigma and social, medical, and legal supports.
Conclusion:
Although TM individuals are vulnerable to HIV and STI, incidence data are lacking. There is a dearth of research on the experiences, risk factors, and sexual behaviors of TM individuals, especially those who are nonbinary or ethnoracially minoritized. The collection of gender identity data in routine HIV surveillance is recommended. Services and interventions developed by and for TM individuals are needed.
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References
1.
GoodmanM, AdamsN, CorneilT, et al.Size and distribution of transgender and gender nonconforming populations: A narrative review. Endocrinol Metab Clin North Am, 2019; 48(2):303–321; doi: 10.1016/j.ecl.2019.01.001
2.
StutterheimSE, van DijkM, WangH, et al.The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One, 2021; 16(12):e0260063; doi: 10.1371/journal.pone.0260063
3.
LandovitzRJ, DonnellD, ClementME, et al.Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med, 2021; 385(7):595–608; doi: 10.1056/NEJMoa2101016
4.
HPTN 091—Integrating HIV Prevention, Gender-Affirmative Medical Care, and Peer Health Navigation to Prevent HIV Acquisition and HIV Transmission for Transgender Women in the Americas: A Vanguard Feasibility and Acceptability Study; 2022. Available from: https://www.hptn.org/research/studies/hptn091 [Last accessed: October 13, 2022].
5.
ReisnerSL, MurchisonGR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health, 2016; 11(7–8):866–887; doi: 10.1080/17441692.2015.1134613
6.
BrooksVR.Minority Stress and Lesbian Women. Lexington Books: Lexington, MA; 1981.
7.
MeyerIH. Resilience in the study of minority stress and health of sexual and gender minorities. Psychol Sex Orientat Gend Divers, 2015; 2:209–213; doi: 10.1037/sgd0000132
8.
TestaRJ, HabarthJ, PetaJ, et al.Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers, 2015; 2:65–77; doi: 10.1037/sgd0000081
9.
BecasenJS, DenardCL, MullinsMM, et al.Estimating the prevalence of HIV and sexual behaviors among the US transgender population: A systematic review and meta-analysis, 2006–2017. Am J Public Health, 2019; 109(1):e1–e8; doi: 10.2105/ajph.2018.304727
10.
Van GerwenOT, JaniA, LongDM, et al.Prevalence of sexually transmitted infections and human immunodeficiency virus in transgender persons: A systematic review. Transgend Health, 2020; 5(2):90–103; doi: 10.1089/trgh.2019.0053
11.
CohenMS, CouncilOD, ChenJS. Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy. J Int AIDS Soc, 2019; 22(Suppl 6):25355; doi: 10.1002/jia2.25355
12.
CumpstonM, LiT, PageMJ, et al.Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019; 10:Ed000142; doi: 10.1002/14651858.Ed000142
13.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021; 372:n71; doi: 10.1136/bmj.n71
14.
Covidence Systematic Review Software.v3006. Veritas Health Innovation: Melbourne, Australia.
15.
ArkseyH, O'MalleyL. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol, 2005; 8(1):19–32; doi: 10.1080/1364557032000119616
FeldmanJ, RomineRS, BocktingWO. HIV risk behaviors in the U.S. transgender population: Prevalence and predictors in a large internet sample. J Homosex, 2014; 61(11):1558–1588; doi: 10.1080/00918369.2014.944048
18.
GreenN, HoeniglM, MorrisS, et al.Risk behavior and sexually transmitted infections among transgender women and men undergoing community-based screening for acute and early HIV infection in San Diego. Medicine (Baltimore), 2015; 94(41):e1830; doi: 10.1097/md.0000000000001830
19.
ReisnerSL, VettersR, WhiteJM, et al.Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center. AIDS Care, 2015; 27(8):1031–1036; doi: 10.1080/09540121.2015.1020750
20.
ReisnerSL, HughtoJM, PardeeDJ, et al.LifeSkills for men (LS4M): Pilot evaluation of a gender-affirmative HIV and STI prevention intervention for young adult transgender men who have sex with men. J Urban Health, 2016; 93(1):189–205; doi: 10.1007/s11524-015-0011-z
21.
DadasovichR, AuerswaldC, MinnisAM, et al.Testosterone and sexual risk among transmen: A mixed methods exploratory study. Cult Health Sex, 2017; 19(2):256–266; doi: 10.1080/13691058.2016.1216605
22.
ManglaN, MamunR, WeisbergI. Hepatitis screening in transgender patients with gender identity hormonal therapy. Gastroenterology, 2017; 152(5):S1193–S1194
23.
McFarlandW, WilsonEC, RaymondHF. HIV prevalence, sexual partners, sexual behavior and HIV acquisition risk among trans men, San Francisco, 2014. AIDS Behav, 2017; 21(12):3346–3352; doi: 10.1007/s10461-017-1735-4
24.
ReisnerSL, Jadwin-CakmakL, White HughtoJM, et al.Characterizing the HIV prevention and care continua in a sample of transgender youth in the U.S. AIDS Behav, 2017; 21(12):3312–3327; doi: 10.1007/s10461-017-1938-8
25.
RichA, ScottK, JohnstonC, et al.Sexual HIV risk among gay, bisexual and queer transgender men: Findings from interviews in Vancouver, Canada. Cult Health Sex, 2017; 19(11):1197–1209; doi: 10.1080/13691058.2017.1299882
26.
ScheimAI, TraversR. Barriers and facilitators to HIV and sexually transmitted infections testing for gay, bisexual, and other transgender men who have sex with men. AIDS Care, 2017; 29(8):990–995; doi: 10.1080/09540121.2016.1271937
27.
ScheimAI, BauerGR, TraversR. HIV-related sexual risk among transgender men who are gay, bisexual, or have sex with men. J Acquir Immune Defic Syndr, 2017; 74(4):e89–e96; doi: 10.1097/qai.0000000000001222
28.
BellhouseC, WalkerS, FairleyCK, et al.Patterns of sexual behaviour and sexual healthcare needs among transgender individuals in Melbourne, Australia, 2011–2014. Sex Transm Infect, 2018; 94(3):212–215; doi: 10.1136/sextrans-2016-052710
29.
CostaAB, FontanariAMV, CatelanRF, et al.HIV-related healthcare needs and access barriers for Brazilian transgender and gender diverse people. AIDS Behav, 2018; 22(8):2534–2542; doi: 10.1007/s10461-017-2021-1
30.
FisherCB, FriedAL, DesmondM, et al.Perceived barriers to HIV prevention services for transgender youth. LGBT Health, 2018; 5(6):350–358; doi: 10.1089/lgbt.2017.0098
31.
Perez-BrumerA, NunnA, HsiangE, et al.“We don't treat your kind”: Assessing HIV health needs holistically among transgender people in Jackson, Mississippi. PLoS One, 2018; 13(11):e0202389; doi: 10.1371/journal.pone.0202389
32.
ShoverCL, DeVostMA, BeymerMR, et al.Using sexual orientation and gender identity to monitor disparities in HIV, sexually transmitted infections, and viral hepatitis. Am J Public Health, 2018; 108(Suppl 4):S277–s283; doi: 10.2105/ajph.2018.304751
33.
CallanderD, CookT, ReadP, et al.Sexually transmissible infections among transgender men and women attending Australian sexual health clinics. Med J Aust, 2019; 211(9):406–411; doi: 10.5694/mja2.50322
34.
FontanariAMV, ViannaLL, SchneiderM, et al.A retrospective review of medical records of laboratory-tested sexually transmitted infections of transsexual men from Southern Brazil. Arch Sex Behav, 2019; 48(5):1573–1579; doi: 10.1007/s10508-019-1395-8
35.
PitasiMA, KeraniRP, KohnR, et al.Chlamydia, gonorrhea, and human immunodeficiency virus infection among transgender women and transgender men attending clinics that provide sexually transmitted disease services in six US cities: Results from the sexually transmitted disease surveillance network. Sex Transm Dis, 2019; 46(2):112–117; doi: 10.1097/olq.0000000000000917
36.
ReisnerSL, Jadwin-CakmakL, SavaL, et al.Situated vulnerabilities, sexual risk, and sexually transmitted infections' diagnoses in a sample of transgender youth in the United States. AIDS Patient Care STDS, 2019; 33(3):120–130; doi: 10.1089/apc.2018.0249
37.
SharmaA, KahleE, ToddK, et al.Variations in testing for HIV And Other Sexually Transmitted Infections Across Gender Identity Among Transgender Youth. Transgend Health, 2019; 4(1):46–57; doi: 10.1089/trgh.2018.0047
38.
TordoffDM, MorganJ, DombrowskiJC, et al.Increased ascertainment of transgender and non-binary patients using a 2-step versus 1-step gender identity intake question in an STD clinic setting. Sex Transm Dis, 2019; 46(4):254–259; doi: 10.1097/olq.0000000000000952
39.
Antebi-GruszkaN, TalanAJ, ReisnerSL, et al.Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men. Sex Transm Infect, 2020; 96(6):422–427; doi: 10.1136/sextrans-2020-054474
40.
FerlatteO, PanwalaV, RichAJ, et al.Identifying health differences between transgender and cisgender gay, bisexual and other men who have sex with men using a community-based approach. J Sex Res, 2020; 57(8):1005–1013; doi: 10.1080/00224499.2020.1740148
41.
HicksonF, AppenrothM, KoppeU, et al.Sexual and mental health inequalities across gender identity and sex-assigned-at-birth among men-who-have-sex-with-men in Europe: Findings from EMIS-2017. Int J Environ Res Public Health, 2020; 17(20):1–20; doi: 10.3390/ijerph17207379
42.
LogieCH, Perez-BrumerA, MothopengT, et al.Conceptualizing LGBT stigma and associated HIV vulnerabilities among LGBT persons in Lesotho. AIDS Behav, 2020; 24(12):3462–3472; doi: 10.1007/s10461-020-02917-y
43.
PlettaDR, White HughtoJM, PeitzmeierS, et al.Individual- and partnership-level correlates of protective barrier use in a sample of transmasculine adults with diverse sexual partnerships. AIDS Patient Care STDS, 2020; 34(5):237–246; doi: 10.1089/apc.2019.0296
44.
ReisnerSL, MooreCS, AsquithA, et al.Gender non-affirmation from cisgender male partners: Development and validation of a Brief Stigma Scale for HIV research with transgender men who have sex with men (trans MSM). AIDS Behav, 2020; 24(1):331–343; doi: 10.1007/s10461-019-02749-5
45.
SeveliusJM, PoteatT, LuhurWE, et al.HIV testing and PrEP use in a national probability sample of sexually active transgender people in the United States. J Acquir Immune Defic Syndr, 2020; 84(5):437–442; doi: 10.1097/qai.0000000000002403
46.
StephensonR, ToddK, KahleE, et al.Project moxie: Results of a feasibility study of a telehealth intervention to increase HIV testing among binary and nonbinary transgender youth. AIDS Behav, 2020; 24(5):1517–1530; doi: 10.1007/s10461-019-02741-z
47.
CrowellTA, QianH, TiemannC, et al.Factors associated with testing for HIV and hepatitis C among behaviorally vulnerable men in Germany: A cross-sectional analysis upon enrollment into an observational cohort. AIDS Res Ther, 2021; 18(1):52; doi: 10.1186/s12981-021-00378-4
48.
DrücklerS, DaansC, HoornenborgE, et al.HIV and STI positivity rates among transgender people attending two large STI clinics in the Netherlands. Sex Transm Infect, 2021; 98(3):188–196; doi: 10.1136/sextrans-2020-054875
49.
GassBV, HorvathKJ, MarrowE, et al.Associations between social support availability and HIV risk and protective factors in a U.S. sample of adults with diverse transgender identities. LGBT Health, 2021; 8(1):60–67; doi: 10.1089/lgbt.2020.0035
50.
MujugiraA, KasiitaV, BagayaM, et al.“You are not a man”: A multi-method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda. J Int AIDS Soc, 2021; 24(12):e25860; doi: 10.1002/jia2.25860
51.
WitzelTC, WrightT, McCabeL, et al.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. EClinicalMedicine, 2021; 32:100700; doi: 10.1016/j.eclinm.2020.100700
52.
ReisnerSL, White HughtoJM, PardeeD, et al.Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. Int J STD AIDS, 2016; 27(11):955–966; doi: 10.1177/0956462415602418
53.
FearonE, TenzaS, MokoenaC, et al.HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One, 2020; 15(6):e0234384; doi: 10.1371/journal.pone.0234384
54.
LuzzatiR, ZattaM, PavanN, et al.Prevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among transgender persons referred to an Italian center for total sex reassignment surgery. Sex Transm Dis, 2016; 43(7):407–411; doi: 10.1097/olq.0000000000000452
55.
ReisnerSL, BielloK, RosenbergerJG, et al.Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Arch Sex Behav, 2014; 43(8):1503–1514; doi: 10.1007/s10508-014-0314-2
56.
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019; 2021. Available from: www.cdc.gov/hiv/library/reports/hiv-surveillance.html [Last accessed: September17, 2023].
57.
JonesT. Researching and working for transgender youth: Contexts, problems and solutions. Soc Sci, 2016; 5(3):43.
58.
WinterS, DiamondM, GreenJ, et al.Transgender people: Health at the margins of society. Lancet, 2016; 388(10042):390–400; doi: 10.1016/s0140-6736(16)00683-8
59.
Owen-SmithAA, WoodyattC, SineathRC, et al.Perceptions of barriers to and facilitators of participation in health research among transgender people. Transgend Health, 2016; 1(1):187–196; doi: 10.1089/trgh.2016.0023
60.
ReisnerSL, MooreCS, AsquithA, et al.High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States. J Int AIDS Soc, 2019; 22(9):e25391; doi: 10.1002/jia2.25391
61.
GolubSA, FikslinRA, StarbuckL, et al.High rates of PrEP eligibility but low rates of PrEP access among a national sample of transmasculine individuals. J Acquir Immune Defic Syndr, 2019; 82(1):e1–e7; doi: 10.1097/qai.0000000000002116
62.
RiouxC, ParéA, London-NadeauK, et al.Sex and gender terminology: A glossary for gender-inclusive epidemiology. J Epidemiol Community Health, 2022. [Epub ahead of print]; doi: 10.1136/jech-2022-219171
63.
LettE, EverhartA. Considerations for transgender population health research based on US national surveys. Ann Epidemiol, 2022; 65:65–71; doi: 10.1016/j.annepidem.2021.10.009
National Academies of Sciences, Engineering, Medicine, Division of Behavioral and Social Sciences and Education. The National Academies Collection: Reports Funded by National Institutes of Health. In: Measuring Sex, Gender Identity, and Sexual Orientation. (BeckerT, ChinM, BatesN. eds.) National Academies Press (US): Washington (DC); 2022.
67.
SeveliusJ. “There's no pamphlet for the kind of sex I have”: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care, 2009; 20(5):398–410; doi: 10.1016/j.jana.2009.06.001
68.
RosenbergS, CallanderD, HoltM, et al.Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey. PLoS One, 2021; 16(7):e0253589; doi: 10.1371/journal.pone.0253589
69.
ScheimAI, AppenrothMN, BeckhamSW, et al.Transgender HIV research: Nothing about us without us. Lancet HIV, 2019; 6(9):e566–e567; doi: 10.1016/s2352-3018(19)30269-3
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