Abstract
Background
Transgender women experience a disproportionate burden of HIV. National-level trend analyses in South Africa remain limited. This study asked whether modelled HIV prevalence among transgender women changed between 2022 and 2026, and whether disparities relative to the national population and adult females had narrowed over this period.
Methods
A quantitative ecological analysis was conducted using modelled estimates from the Thembisa model (version 4.8) (2022–2026). Annual HIV prevalence and 95% confidence intervals were extracted. Estimates for 2022 and 2023 reflect retrospective modelled outputs, while estimates for 2024 to 2026 incorporate model projections. A Mann-Kendall trend test was conducted to assess the statistical significance of observed changes. Absolute differences and prevalence ratios were calculated.
Results
HIV prevalence among transgender women declined from 43% in 2022 to 40% in 2026. National prevalence remained stable (13%). The absolute gap decreased from 30 to 27 percentage points. In 2026, HIV prevalence among transgender women remained more than three times higher than national prevalence. The Mann-Kendall trend test confirmed a statistically significant downward trend (τ = −1.00, p = 0.017).
Conclusion
Despite modest declines, substantial disparities persist. Continued monitoring and targeted HIV strategies remain essential. These findings carry direct implications for South Africa’s National Strategic Plan on HIV and for the National Department of Health’s key population programming.
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