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AIDS and Behavior

, Volume 12, Issue 1, pp 1–17 | Cite as

Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review

  • Jeffrey H. Herbst
  • Elizabeth D. Jacobs
  • Teresa J. Finlayson
  • Vel S. McKleroy
  • Mary Spink Neumann
  • Nicole Crepaz
  • for the HIV/AIDS Prevention Research Synthesis Team
Review Paper

Abstract

Transgender populations in the United States have been impacted by the HIV/AIDS epidemic. This systematic review estimates the prevalence of HIV infection and risk behaviors of transgender persons. Comprehensive searches of the US-based HIV behavioral prevention literature identified 29 studies focusing on male-to-female (MTF) transgender women; five of these studies also reported data on female-to-male (FTM) transgender men. Using meta-analytic approaches, prevalence rates were estimated by synthesizing weighted means. Meta-analytic findings indicated that 27.7% (95% confidence interval [CI], 24.8–30.6%) of MTFs tested positive for HIV infection (four studies), while 11.8% (95% CI, 10.5–13.2%) of MTFs self-reported being HIV-seropositive (18 studies). Higher HIV infection rates were found among African-American MTFs regardless of assessment method (56.3% test result; 30.8% self-report). Large percentages of MTFs (range, 27–48%) reported engaging in risky behaviors (e.g., unprotected receptive anal intercourse, multiple casual partners, sex work). Prevalence rates of HIV and risk behaviors were low among FTMs. Contextual factors potentially related to increased HIV risk include mental health concerns, physical abuse, social isolation, economic marginalization, and unmet transgender-specific healthcare needs. Additional research is needed to explain the causes of HIV risk behavior of transgender persons. These findings should be considered when developing and adapting prevention interventions for transgender populations.

Keywords

Transgender persons Male-to-female Female-to-male HIV prevalence HIV risk behaviors 

Notes

Acknowledgements

Other members of the HIV/AIDS Prevention Research Synthesis (PRS) Team who contributed to this review include (listed alphabetically): Julia B. DeLuca, Linda S. Kay, Cynthia M. Lyles, Mary Mullins, Sima M. Rama, and Sekhar Thadiparthi.

The authors thank A. J. King of the California STD/HIV Prevention Training Center and JoAnne Keatley of the Pacific AIDS Education and Training Center, University of California San Francisco for providing insightful comments on an earlier version of this article. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jeffrey H. Herbst
    • 1
  • Elizabeth D. Jacobs
    • 1
  • Teresa J. Finlayson
    • 2
  • Vel S. McKleroy
    • 1
  • Mary Spink Neumann
    • 1
  • Nicole Crepaz
    • 1
  • for the HIV/AIDS Prevention Research Synthesis Team
  1. 1.Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB PreventionCenters for Disease Control and PreventionAtlantaUSA

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