Global burden of stigma and discrimination against transgender and gender-diverse adults: a systematic review and meta-analysis

ImportanceStigma and discrimination against transgender and gender-diverse people are prevalent across many settings and may contribute to substantial health disparities. ObjectiveTo synthesize global evidence on the prevalence of stigma, discrimination, and resilience among transgender (trans) and gender-diverse adults. Data SourcesA systematic search was conducted in PubMed, Embase, CINAHL, Cochrane Central, LILACS, and PsycInfo for articles published between January 1, 2010 and January 2, 2023. This database search was supplemented by grey literature and secondary reference searches. Article SelectionStudies were eligible if they presented primary quantitative data on prevalence of stigma, discrimination, and/or resilience among trans and gender-diverse adults (aged 18 and over), with no restrictions on study design, language, or geographic region. Data Extraction and SynthesisTwo independent reviewers extracted data using standardized forms, with discrepancies resolved by consensus. The JBI Critical Appraisal Checklist for Prevalence Articles was used to assess risk of bias. Random effects meta-analysis was conducted for dichotomous prevalence measures using inverse variance weighting and logit transformation; non-dichotomous prevalence data were summarized descriptively. Main Outcomes and MeasuresOutcomes included prevalence estimates for various forms of stigma (anticipated, perceived, internalized, and experienced), discrimination in legal/institutional settings (housing, healthcare, employment, police/prison), and resilience. ResultsA total of 97 articles, with data from 72,158 unique trans and gender-diverse participants across 26 countries, met inclusion criteria. Studies showed moderate levels of anticipated stigma, perceived stigma, and internalized stigma. Meta-analyses of 36 studies provided pooled estimates of discrimination prevalence across multiple domains: 21.4% in housing (e.g., eviction, rental denial), 24.6% in healthcare (e.g., denial of care, mistreatment), 32.8% in employment (e.g., hiring bias, workplace harassment), and 39.1% in police/prison settings (e.g., profiling, mistreatment). High heterogeneity was observed across studies, reflecting regional and methodological differences. Resilience scores ranged from moderate to high, indicating variation within trans and gender-diverse communities. Conclusions and RelevanceThis systematic review and meta-analysis found that stigma and discrimination against trans and gender-diverse adults are pervasive globally. Variation in stigma and discrimination across settings and regions underscores the need for targeted interventions and policy reforms. FundingWorld Health Organization through a grant from the Elton John AIDS Foundation and the Bill and Melinda Gates Foundation. Key PointsQuestion: What is the global prevalence of stigma, discrimination, and resilience among trans and gender-diverse adults? Findings: A systematic review of 97 articles, and meta-analysis of a subset of 36 articles, found elevated prevalence of stigma in non-institutional settings, discrimination in institutional settings, and resilience. Meaning: These findings illustrate that stigma and discrimination against trans and gender-diverse adults are pervasive globally and should be addressed through targeted interventions and policy reform.