The HIV Burden Among Men Who Have Sex with Men, Transgender People, and Male and Transgender Sex Workers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

Background: Sub-Saharan Africa (SSA) bears the highest HIV burden worldwide with regional disparities between west and central Africa (WCA) and eastern and southern Africa (ESA). The HIV burden among men who have sex with men (MSM), transgender-women and -men, and male and transgender sex workers (SW) in SSA is largely unknown. We estimated the relative HIV risk and absolute HIV burden for these groups in SSA. Methods: We performed a systematic review of peer-reviewed literature, published between 2010 and 2020 that assessed HIV prevalence in MSM, transgender-women and -men, and male and transgender SW in SSA, following the PRISMA guidelines. The databases Embase, Medline Epub, Web of Science and Google Scholar were searched. Risk of bias was assessed using JBI critical appraisal checklist. We calculated HIV risk ratios (RRs) based on HIV prevalences from each study population and the geospatially matched HIV prevalence among the general population. We extrapolated results for MSM and transgender women to estimate HIV prevalence and number of HIV positives for each country in SSA. Findings: We found 44 articles assessing HIV prevalence in MSM, four in transgender women, five in male SW, and zero in transgender men and transgender SW. Prevalence among MSM, transgender women and male SW was significantly higher compared to the general population in both WCA (RRs: 9·3, 7·1, and 12·4 respectively) and ESA (RRs: 1·8, 1·4, and 8·6 respectively). Estimated HIV prevalence for MSM was 15% and 27% for transgender women, translating in into about 400,000-1,600,000 MSM and between 300,000-600,000 transgender women living with HIV in SSA. For male SW insufficient data was available for such extrapolation. Interpretation: HIV burden among MSM, transgender women and male SW throughout SSA are alarmingly high. Our findings further highlight the urgent need for scaling-up tailored HIV prevention and treatment interventions for these populations. Funding: Aidsfonds Netherlands. Declaration of Interest: None to declare.