HIV prevalence in transgender populations and cisgender men who have sex with men in sub-Saharan Africa 2010-2022: a meta-analysis

IntroductionThe Global AIDS Strategy 2021-2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalised and experience disproportionate risk of HIV infection in sub-Saharan Africa (SSA) and data to guide HIV programmes are severely limited. Surveillance data among cisgender men who have sex with men (cis-MSM) are comparatively abundant. We assessed whether HIV prevalence among cis-MSM was correlated with HIV prevalence among transgender women. MethodsData from key population surveys conducted in SSA between 2010-2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both transgender women and cis-MSM populations were analysed with random effect meta-analysis to estimate the ratio of HIV prevalence among cis-MSM:transgender women. ResultsTwenty-one studies were identified encompassing 8,476 transgender women and 24,102 cis-MSM. Median HIV prevalence among transgender women was 23.5% (interquartile range [IQR] 11.5-39.8%) and 16.2% (IQR 8.1-26.8%) among cis-MSM. HIV prevalence among transgender women was 50% higher than in cis-MSM (prevalence ratio 1.48 95CI 1.25-1.76). HIV prevalence among transgender women was highly correlated with year/province-matched HIV prevalence among cis-MSM (R2=0.60), but poorly correlated with year/province-matched total population HIV prevalence (R2=0.01). ConclusionTransgender women experience a significantly greater HIV burden than cis-MSM in SSA, underscoring the need for HIV services addressing the disproportionate vulnerability experienced by transgender women. Further bio-behavioural surveys focused on determinants of HIV infection, treatment uptake, and risk behaviours among transgender people, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities.