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Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013. Global Burden of HIV Trans Populations. Marginalized and Overlooked. Limits to Knowledge Base Routine health surveillance and monitoring of transgender populations globally is rare
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Tonia Poteat, PhD, MPH, PA-C Trans Inclusion Panel, FCAA 9 December 2013 Global Burden of HIV Trans Populations
Marginalized and Overlooked • Limits to Knowledge Base • Routine health surveillance and monitoring of transgender populations globally is rare • Transgender women historically included together men who have sex with men (MSM) in HIV surveillance • Transgender men are invisible • Result • Limited understanding of determinants of risk among transgender populations in most of the world
Background Data • Operario et al 2008 • Pooled HIV prevalence: • 27.3% among trans women engaging in sex work • 14.7% trans women not engaging in sex work • Herbst et al 2008 • Pooled U.S. HIV prevalence: • 27.7% (range: 16% to 68%) (laboratory-confirmed)
Systematic Review: Inclusion Criteria • Published January 1, 2000 to November 30, 2011 • Languages: English, French, Spanish • Databases: PubMed, EMBASE, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine • Search terms • medical subject headings (MeSH) terms for HIV or AIDS, and terms associated with transgender ( transgender* OR “travesty” OR “koti” OR “hijra” OR “MTF” or “male to female transgender” OR transsexual* OR transvest* OR “mahuvahine” OR “mahu” OR “waria” OR katoey OR “cross dresser” OR “bantut” OR “nadleehi” OR “mahu” OR “berdache” OR “xanith”).
Search Results 39 studies in 15 countries 11,066 transgender women
Pooled Estimate of HIV Pooled estimate 19.1%
Meta-Analysis of HIV Prevalence Data Odds Ratio = 49 (31.2, 76.3)
HIV Among Trans Women by Income Level Baral et al., 2013
Technical Report:The Global Health Needs of Transgender PopulationsA Review to Inform the President’s Emergency Plan for AIDS Relief (PEPFAR) Programming December 4, 2013 Stefan Baral, MD, MPH, FRCPC Sari Reisner, ScD, MA
Research Synthesis - Methods • January 1, 2008 to May 28, 2013 • Pubmed, Embase, Ovid, Psychinfo, CINAHL PLUS, Web of Science, Sociological Abstracts, and Medadvocates (peer-reviewed) • WHO publications, National Library of Medicine’s Meeting Abstracts, New York Academy of Medicine- Grey Literature Report, FHI, PSI, Population Council, CDC, Public Health Agency of Canada, Pan American Health Organization, Google, WPATH, The Fenway Institute, AMSA, The Center of Excellence for Transgender Health, USAID, UNAIDS, UNDP, UNESCO, Columbia University, University of Hong Kong, AIDS Health Care Foundation, The Global Forum on MSM and HIV, Gay Lesbian Medical Association, The International HIV/AIDS Alliance, AEGIS Search, International AIDS Society (IAS), and JSI (non-peer reviewed grey literature) • English language • “Transgender” cross-referenced with terms for “Health” and “HIV” • common terms for “transgender” used around the world such as hijra, waria, etc. • terms similar to transgender such as travesti, transvestite, and trans man
HIV in Trans Men • Data sources: • 13 peer-reviewed papers • 2 non-peer review needs assessments • HIV prevalence • 0% and 2.9% (2 laboratory-confirmed) • 0% to 10% (self-report) • Data only available from U.S. and Canada
Conclusions • Trans women bear a very high burden of HIV infection in both low and high income countries • Studies only available from concentrated epidemics • No data available from SSA or EE/CA • Very scant data on HIV among trans men • Only 2 laboratory-confirmed studies • Trans MSM are increasingly visible - more data needed • We must explicitly include trans populations in HIV research and disaggregate the data in order to have relevant and actionable information
“I was shocked at how hard it is to raise funds for a trans* organization.” “It’s very hard for us to identify funding organizations with criteria that we meet ... intersex isn’t on their list.” “We’re just not on funders’ radar.” “As we are “T” specific, it is difficult to access LGBT funding.”
Number of New Groups Founded 1985-2013, by Leadership Demographics
Budget of Groups 2012 Budget (n=324) and 2013 Budget (n=338)
2013 Funding Sources (n=335) Percentage of Groups that Received Funding from These Sources