In The Lancet HIV, Venkatesan Chakrapani1Need for transgender-specific data from Africa and elsewhere. commented on the study by Adrian D Smith and colleagues2Smith AD Kimani J Kabuti R Weatherburn P Fearon E Bourne A HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study. and suggested transgender-specific data collection to inform the redress of health inequalities. We believe heeding this call for transgender-specific data could benefit efforts in Asia to identify gaps in HIV response for transgender people.First, transgender-specific HIV care cascade data are scarce. This scarcity could be because the data are usually merged with data from men who have sex with men (MSM) or not reported due to negligence or not enough attention being paid to this group of people.3van Griensven F de Lind van Wijngaarden JW Eustaquio PC et al.The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming. Among the countries where data were available, HIV prevalence among transgender people reached 24·8% in 2019 in Indonesia, and increased in countries that used integrated biological and behavioural surveillance (eg, Cambodia, Malaysia, and Thailand).3van Griensven F de Lind van Wijngaarden JW Eustaquio PC et al.The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming., 4UNAIDS
HIV and AIDS data hub for Asia Pacific. The percentage of transgender people reporting HIV testing in the past year ranged from 15% (Philippines) to 89% (Nepal). However, the percentage of transgender people with HIV receiving antiretroviral therapy was not reported, or low if available.4UNAIDS
HIV and AIDS data hub for Asia Pacific. Hence, Asian countries need to include transgender people as a separate group in HIV surveillance programmes and expand current programmes to include smaller cities and rural areas.Second, use of HIV prevention services is low among transgender people in Asia. As of 2019, less than 50% of transgender people reportedly received a combined set of HIV prevention interventions in Bangladesh, Nepal, Pakistan, Philippines, and Sri Lanka.4UNAIDS
HIV and AIDS data hub for Asia Pacific. Data on the use of pre-exposure prophylaxis (PrEP) were consistently included with data from MSM in Asia.3van Griensven F de Lind van Wijngaarden JW Eustaquio PC et al.The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming. Our cross-sectional study reported in 2020 also showed a low PrEP uptake among transfeminine people in China (24 [8·7%] of 277 people).5

Sha Y, Dong W, Zheng L, Muessig K, Tang W, Tucker JD. Unmet health needs and gender minority stress among transgender individuals: a cross-sectional study in China. UNC Project-China Annual Meeting; Guangzhou, China; 2020 (abstr 12).

Additionally, societal stigma and discrimination consistently hindered transgender people's access to PrEP and other HIV services in Asia.3van Griensven F de Lind van Wijngaarden JW Eustaquio PC et al.The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming., 6Addressing unmet health needs among Chinese transgender individuals. Therefore, it is crucial to consider the socioecological systems that dictate access to HIV care and to plan data collection strategies accordingly. We suggest researchers collect interpersonal and structural-level data through both quantitative and qualitative methods when considering health inequalities in transgender people.Third, few data exist on mental health and gender-affirming interventions among transgender people in Asia.7Zhu X Gao Y Gillespie A et al.Health care and mental wellbeing in the transgender and gender-diverse Chinese population. Using the gender minority stress framework, our study in China found that gender-identity-related stress can effect transgender people's engagement with gender-affirming interventions and HIV prevention services.5

Sha Y, Dong W, Zheng L, Muessig K, Tang W, Tucker JD. Unmet health needs and gender minority stress among transgender individuals: a cross-sectional study in China. UNC Project-China Annual Meeting; Guangzhou, China; 2020 (abstr 12).

As access to HIV care services is interconnected with mental health and gender affirmation,8Shaikh S Mburu G Arumugam V et al.Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India. we recommend collecting data related to these area to address health inequalities.

Now is the time to tackle health inequalities for transgender people.

We declare no competing interests. This work was supported by the National Nature Science Foundation of China (81903371), the National Key Research and Development Program of China (2017YFE0103800), the National Institutes of Health (NIAID K24AI143471), the University of North Carolina Center for AIDS Research (NIAID 5P30AI050410), and the National Institute of Mental Health (R34MH119963).

References1.

Need for transgender-specific data from Africa and elsewhere.

Lancet HIV. 8: e249-e2502.Smith AD Kimani J Kabuti R Weatherburn P Fearon E Bourne A

HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study.

Lancet HIV. 8: e274-e2833.van Griensven F de Lind van Wijngaarden JW Eustaquio PC et al.

The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming.

Sex Health. 18: 21-304.

HIV and AIDS data hub for Asia Pacific.

5.

Sha Y, Dong W, Zheng L, Muessig K, Tang W, Tucker JD. Unmet health needs and gender minority stress among transgender individuals: a cross-sectional study in China. UNC Project-China Annual Meeting; Guangzhou, China; 2020 (abstr 12).

6.

Addressing unmet health needs among Chinese transgender individuals.

Sex Health. ()7.Zhu X Gao Y Gillespie A et al.

Health care and mental wellbeing in the transgender and gender-diverse Chinese population.

Lancet Diabetes Endocrinol. 7: 339-3418.Shaikh S Mburu G Arumugam V et al.

Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India.

J Int AIDS Soc. 1920809Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S2352-3018(21)00080-1

Copyright

© 2021 Elsevier Ltd. All rights reserved.

ScienceDirectAccess this article on ScienceDirect Linked ArticlesNeed for transgender-specific data from Africa and elsewhere

Transfeminine people, or transgender women, have been shown to have a large HIV burden worldwide.1 Until 5–10 years ago, an apparent conflation of gender and sex had led several countries to inappropriately categorise transfeminine people as men who have sex with men (MSM), a behavioural term coined by WHO. A WHO report from 2018 highlighted that only ten (22%) of 45 national HIV strategic plans from African countries mentioned transgender people, and only four (9%) offered interventions.2 UNAIDS notes that countries with generalised HIV epidemics, like some countries in Africa, might also have concentrated subepidemics among transgender people, and recommends reporting on several indicators (eg, HIV prevalence, use of antiretroviral therapy).

Full-Text PDF