title: Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.
abstract: BACKGROUND
  Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide.
  
  
  METHODS
  We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available.
  
  
  RESULTS
  Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4-20·7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6-19·8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8-24·3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2-76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries.
  
  
  CONCLUSIONS
  Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women.
  
  
  BACKGROUND
  Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.
authors.affiliation: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA. sbaral@jhsph.edu
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Baral
authors.forename: Tonia
authors.initials: T
authors.lastname: Poteat
authors.forename: Susanne
authors.initials: S
authors.lastname: Strömdahl
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Guadamuz
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D001208:Asia / Q000453:epidemiology; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D004544:El Salvador / Q000453:epidemiology; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D013020:South America / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D063106:Transgender Persons / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D008297:Male