"Transgender women are a key risk group for HIV, and epidemiologic studies have attributed high rates of HIV infection to behaviors associated with sex work in this population. This systematic review compared HIV prevalence among transgender female sex workers (TFSWs) with prevalence among transgender women who do not engage in sex work, male sex workers and biologically female sex workers," explained the study authors.

Systematic searches of six electronic databases were performed, and studies that met pre-established criteria were included. The researchers extracted data, appraised methodologic quality, assessed heterogeneity, and organized meta-analyses by comparison group.

Twenty-five studies involving 6,405 participants recruited from 14 countries were identified. Overall crude HIV prevalence was 27.3 percent in TFSWs, 14.7 percent in transgender women not engaging in sex work, 15.1 percent in male sex workers, and 4.5 percent in female sex workers. Meta-analysis showed that TFSWs had significantly higher risk for HIV infection compared to all other groups (relative risk [RR]=1.46, 95 percent confidence interval [CI]: 1.02 to 2.09) -- particularly in comparison to female sex workers (RR=4.02, 95 percent CI: 1.06 to 10.11). Significant heterogeneity among the included studies was observed, in addition to methodologic limitations and imprecise definitions of sex work and gender.

"TFSWs could benefit from targeted HIV prevention interventions, HIV testing and interventions to help reduce the risk of contracting or transmitting HIV," the authors concluded. "Structural interventions to reduce reliance on sex work among transgender women may be warranted."

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