title: Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People.
abstract: Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations.
  
  
  
  A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations.
  
  
  
  Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations.
  
  
  
  Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
authors.affiliation: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Epidemiology and Biostatistics, Western University, London, Canada; ‡U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland; and §Boston Children's Hospital/Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Tonia
authors.initials: T
authors.lastname: Poteat
authors.forename: Ayden
authors.initials: A
authors.lastname: Scheim
authors.forename: Jessica
authors.initials: J
authors.lastname: Xavier
authors.forename: Sari
authors.initials: S
authors.lastname: Reisner
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D003863:Depression / Q000453:epidemiology*; D058872:Epidemics; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners / Q000523:psychology; D012931:Social Environment; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000453:epidemiology*; D063106:Transgender Persons / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*