title: HIV risk and preventive interventions in transgender women sex workers.
abstract: Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population.
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: tpoteat@jhsph.edu.
authors: Tonia
authors: T
authors: Poteat
authors: Johns Hopkins Medical Institute, Baltimore, MD, USA.
authors: Andrea L
authors: AL
authors: Wirtz
authors: Callen Lorde Community Health Center, New York, NY, USA.
authors: Anita
authors: A
authors: Radix
authors: The HIV Modelling Consortium, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors: Annick
authors: A
authors: Borquez
authors: Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Alfonso
authors: A
authors: Silva-Santisteban
authors: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California-San Francisco, San Francisco, CA, USA.
authors: Madeline B
authors: MB
authors: Deutsch
authors: The Global Fund Project, Center for HIV and AIDS, icddr,b, Dhaka, Bangladesh.
authors: Sharful Islam
authors: SI
authors: Khan
authors: Division of Policy and Social Studies in Education, Faculty of Education, University of Hong Kong, Hong Kong, China.
authors: Sam
authors: S
authors: Winter
authors: School of Public Health, Brown University, Department of Behavioral and Social Sciences, Providence, RI, USA.
authors: Don
authors: D
authors: Operario
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010568:Peru / Q000453:epidemiology; D011287:Prejudice; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D060386:Sex Workers / Q000706:statistics & numerical data*; D057545:Social Stigma; D012944:Social Support; D063106:Transgender Persons / Q000706:statistics & numerical data*