Meta-analysis shows HIV prevalence is 50% higher in transgender women than cis-MSM in sub-Saharan Africa.

INTRODUCTION: The Global AIDS Strategy 2021-2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalized 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. METHODS: Data from key population surveys conducted in SSA between 2010 and 2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence data among 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. RESULTS: Twenty-one studies were identified encompassing 8476 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, 95% confidence interval (CI) 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). CONCLUSION: Transgender 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.