Structural discrimination and HIV-related health outcomes among Black transgender populations in the Southern United States: a scoping review

Abstract

Background Transgender populations are disproportionately impacted by HIV with an overall HIV rate of 13.7%. Non-Hispanic Black/African Americans (44.2%) have the highest transgender HIV prevalence compared to Hispanics (25.8%) and White (6.7%). Moreover, Black transgender populations face debilitating structural level factors including: racism and discrimination, stigma, poverty, unemployment or underemployment, high rates of food insecurity, unstable housing, lack of insurance, criminalization, incarceration, and violence that negatively impact their health and well-being. Methods In this article, we conducted a scoping review to analyze the impact of structural discrimination on HIV prevention, care, and treatment among Black transgender people in the Southern United States. Results Of the 397 articles identified, twelve manuscripts eligible for full-text review were assessed based on the inclusion/exclusion criteria. A total of five articles with a combined total of 341 study participants met the eligibility criteria. All five studies included in this scoping review reported different yet interrelated structural discrimination factors. These were grouped into three categories: (a) socioeconomic factors, (b) access to healthcare, and (c) stigma and discrimination. Conclusions Black transgender populations face extreme structural discrimination creating barriers to access and adherence to HIV prevention, care, and treatment programs. There is an urgent need for additional research and the implementation of tailored, culturally-appropriate, multi-level interventions to address structural discrimination-related factors that increase HIV vulnerability for Black transgender populations.