HIV Risk among Transgender Women: A Systematic Review of the Global Literature

This review examines the global literature concerning HIV/STI risk factors among transgender women (TGW). The effects of marginalization intersecting with sex work, stigma, and abuse as well as sex- and drug-related risk behaviors merit a systematic review to enable a better understanding of how these factors impact HIV/STI transmission among TGW. The current paper synthesizes the results of 36 studies conducted in multiple cultural settings. Though the selected studies similarly found heightened HIV risks faced by TGW, the focuses varied concerning the impacts of HIV-related dynamics. These variances included the effect of sex work, social stigma, various forms of abuse/violence, sex- and substance risk behaviors, mental health, housing, employment, and the relationship between HIV and other STIs. While focus and results varied, the findings are in consensus that a lack of safe-sex knowledge, various forms of abuse/violence, and diminished autonomy accelerate the TGW’s risks of HIV/STIs. Variations in findings may be attributed to specific sociocultural settings and various research methods as well as differences in the risk factors being studied. This points to the need for more empirical studies – particularly those that specifically target TGW and the mechanisms of HIV/STI transmissions among the highly vulnerable population.