Global Human Immunodeficiency Virus Prevalence and Risk Behaviors in Transmasculine Individuals: A Scoping Review

Abstract

Purpose: This scoping review sought to synthesize human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, incidence, risk behaviors, and risk perceptions among transmasculine (TM) individuals globally. Methods: Eligible articles were peer-reviewed observational and interventional studies published in English between August 2, 2014 and November 2, 2021. Four electronic databases were systematically searched: PubMed, Embase, PsycInfo, and Sociological Abstracts and reference lists hand-searched. Results are presented using numerical summary and thematic analysis. Results: Studies meeting inclusion criteria (n=39) spanned 12 countries and 2 multi-region studies. Laboratory-confirmed HIV prevalence ranged from 0% to 4% and self-reported HIV prevalence from 0% to 8%. Laboratory-confirmed STI diagnoses ranged from 1.2% to 7.7% for chlamydia, 0% to 10.5% for gonorrhea, 0% to 6% for syphilis, 1% to 8% for hepatitis C, and 0% to 8% for hepatitis B. Self-reported lifetime diagnosis of any STI ranged from 5.8% to 53.7%. No studies assessed HIV or STI incidence. Lifetime HIV testing prevalence varied from 23% to 89%. Lifetime STI testing prevalence ranged from 31.1% to 70.8%. Pre- and post-exposure prophylaxis use and knowledge were assessed in seven studies. Qualitative studies addressed HIV vulnerabilities and protective factors, including stigma and social, medical, and legal supports. Conclusion: Although TM individuals are vulnerable to HIV and STI, incidence data are lacking. There is a dearth of research on the experiences, risk factors, and sexual behaviors of TM individuals, especially those who are nonbinary or ethnoracially minoritized. The collection of gender identity data in routine HIV surveillance is recommended. Services and interventions developed by and for TM individuals are needed.