Official websites use. Share sensitive information only on official, secure websites. Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers TSW face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV.
Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population.
Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings.
We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. Emerging data show the disproportionate burden of HIV in transgender women and transgender women sex workers TSW compared with other populations. The term transgender refers to a diverse population whose gender identity or expression differs from their assigned sex at birth.
Transgender people are culturally recognised with specific social roles in some countries; in others, they receive little public acknowledgment. However, TSW and their partners and clients, have been largely absent from HIV national surveillance and programme interventions. Invisibility of TSW could be due to misclassification as men who have sex with men MSM or natal female sex workers, or attributable to systematic neglect. Sampling, methodological, and theoretical limitations in studies of TSW further undermine an effective public health response to the needs of this population.
