Abstract
Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom. This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology. We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care. We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services. There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.
Highlights
Almost 40 million people are living with HIV globally.[1]
We focus on the following themes: (1) epidemiological data, (2) syndemic factors, (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to, and engagement with, health care
Trans women are a key group in the HIV epidemic. This is a group at high risk of HIV acquisition, and those living with HIV are at risk of poorer clinical outcomes as a result of the challenges associated with accessing and engaging with HIV care at all points of the care continuum
Summary
Almost 40 million people are living with HIV globally.[1]. Advances in treatment mean that, for those who have access to HIV medication (known as antiretroviral therapy [ART]), life expectancy approaches that of the general population.[2]. 2020, for 90% of all people living with HIV to know their status, for 90% of those diagnosed with HIV to have sustained ART, and for 90% of those on ART to have achieved viral suppression.[4] progress toward these goals is not equitable, with certain groups not reaching these targets.[5] These key populations are at higher risk of acquiring HIV, and may face significant challenges in engaging in HIV care. This in turn may lead to poorer clinical outcomes for the patient and to increased risk of onward HIV transmission
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