TABLE 1—
Estimated Mean Prevalence of HIV Status, Prior Sexually Transmitted Disease Diagnosis, Risky Sexual Behaviors, Drug Use, and Contextual Factors for Transgender Women, Transgender Men, and Transgender Persons Overall (n = 88 Studies): United States, 2006–2017
| Transgender Women |
Transgender Men |
Transgender Persons Overalla |
|||||||||||
| Outcome | κ | Weighted % (95% CI) | I2% | Min–Max % | κ | Weighted %, (95% CI) | I2% | Min–Max % | Pb | κ | Weighted %, (95% CI) | I2% | Min–Max % |
| HIV status and prior STD diagnosis | |||||||||||||
| HIV infection | 43 | 18.8 (14.9, 23.5) | 95 | 0.9–72.7 | 15 | 2.0 (1.0, 4.0) | 51 | 0.3–10.1 | <.001 | 68 | 13.7 (10.9, 16.9) | 97 | 0.3–72.7 |
| Laboratory-confirmed | 13 | 14.2 (8.7, 22.2) | 96 | 1.0–40.7 | 8 | 2.9 (1.1, 7.3) | 37 | 0.4–10.1 | .003 | 24 | 9.2 (6.0, 13.7) | 98 | 0.4–40.1 |
| Self-reported | 30 | 21.0 (15.9, 27.2) | 95 | 0.9–72.7 | 7 | 1.2 (0.4, 3.1) | 28 | 0.3–7.1 | <.001 | 44 | 16.1 (12.0, 21.2) | 98 | 0.3–60.2 |
| By race/ethnicityc | |||||||||||||
| Black | 4 | 44.2 (23.2, 67.5) | 94 | 20.4–66.7 | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . |
| Hispanic | 5 | 25.8 (11.7, 47.7) | 95 | 7.7–60.0 | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . |
| White | 5 | 6.7 (2.6, 16.6) | 83 | 0.2–25.0 | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . |
| Other | 6 | 9.8 (4.2, 21.1) | 87 | 6.5–26.0 | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . | . . . |
| STD diagnosis | 8 | 21.1 (18.0, 24.7) | 66 | 3.0–36.4 | 8 | 28.7 (12.2, 53.9) | 93 | 0.1–100.0 | .46 | 17 | 21.5 (16.7, 27.3) | 98 | 1.2–99.6 |
| HIV testing | 9 | 74.6 (64.3, 82.8) | 91 | 8.0–99.2 | 6 | 69.1 (55.7, 79.9) | 89 | 47.6–93.3 | .48 | 16 | 72.8 (65.1, 79.3) | 89 | 8.0–99.2 |
| PrEP knowledge | 3 | 36.6 (13.7, 67.7) | 95 | 13.7–64.0 | 2 | NA | NA | NA | . . . | 5 | 48.6 (25.6, 72.2) | 95 | 13.7–64.0 |
| Risky sexual behaviors | |||||||||||||
| Sex work | 29 | 37.9 (29.0, 47.7) | 98 | 3.7–82.0 | 10 | 13.1 (6.6, 24.3) | 88 | 1.2–43.8 | .001 | 39 | 31.0 (23.9, 39.0) | 97 | 1.2–82.0 |
| Unprotected sex | 21 | 38.2 (30.5, 46.5) | 97 | 11.9–72.7 | 9 | 24.5 (15.8, 36.0) | 88 | 8.1–43.9 | .051 | 31 | 35.7 (29.4, 42.5) | 96 | 8.1–72.7 |
| Drunk or high during sex | 13 | 37.3 (28.2, 47.4) | 95 | 13.7–71.1 | 3 | 32.4 (16.3, 54.0) | 88 | 25.0–45.7 | .67 | 16 | 36.4 (28.2, 45.5) | 95 | 13.7–71.1 |
| HIV-positive partners | 8 | 20.2 (12.0, 31.8) | 92 | 2.6–54.5 | 4 | 19.5 (8.1, 39.8) | 80 | 3.3–50.0 | .94 | 12 | 20.0 (12.9, 29.7) | 90 | 3.3–54.5 |
| No. of partnersd | 2 | NA | NA | NA | NA | NA | NA | NA | . . . | 5 | 3.8 (2.0, 5.6) | 48 | 2.8–39.4 |
| Multiple partners | 6 | 41.7 (29.0, 55.6) | 96 | 29.0–58.0 | 6 | 43.1 (29.3, 58.2) | 93 | 0.15–86.0 | .89 | 12 | 42.4 (32.8, 52.6) | 95 | 15.0–86.0 |
| Drug use behaviors | |||||||||||||
| Injection drug use | 14 | 10.7 (6.4, 17.2) | 95 | 0.7–40.5 | 5 | 9.3 (3.5, 22.5) | 0 | 1.6–15.6 | .80 | 20 | 10.0 (6.5, 15.2) | 94 | 0.7–40.5 |
| Injection of hormones | 7 | 32.7 (16.7, 54.1) | 97 | 0.8–69.1 | 2 | NA | NA | NA | . . . | 9 | 37.4 (21.3, 56.8) | 97 | 0.8–91.1 |
| Shared needles | 5 | 2.4 (1.0, 5.7) | 79 | 0.3–9.8 | 3 | 2.2 (0.6, 7.9) | 78 | 0.2–5.1 | .92 | 9 | 2.5 (1.2, 4.9) | 72 | 0.2–9.8 |
| Alcohol use | 11 | 47.5 (30.9, 64.6) | 98 | 7.5–88.1 | 5 | 39.6 (18.6, 65.3) | 96 | 10.3–65.2 | .62 | 18 | 45.4 (32.2, 59.3) | 98 | 7.5–88.1 |
| Noninjection drugs | 17 | 36.0 (28.0, 44.8) | 96 | 13.2–70.6 | 9 | 38.1 (25.9, 52.0) | 92 | 9.8–98.4 | .79 | 29 | 34.9 (30.0, 40.0) | 96 | 9.8–98.4 |
| Noninjection hormones | 16 | 67.7 (59.3, 75.1) | 96 | 11.6–97.6 | 7 | 73.4 (60.2, 83.4) | 95 | 41.2–97.8 | .45 | 27 | 67.1 (60.9, 72.8) | 96 | 11.6–97.8 |
| Contextual factors | |||||||||||||
| Depression | 11 | 43.6 (35.4, 52.0) | 91 | 19.6–81.8 | 3 | 54.2 (37.7, 69.8) | 0 | 52.2–54.9 | .27 | 16 | 50.3 (45.3, 55.2) | 98 | 19.6–81.8 |
| Suicide attempts | 2 | NA | NA | NA | 2 | NA | NA | NA | . . . | 6 | 24.8 (18.0, 33.2) | 99 | 7.1–40.3 |
| Abuse | 9 | 55.8 (37.1, 72.9) | 98 | 18.9–93.7 | 2 | NA | NA | NA | . . . | 14 | 47.8 (30.2, 66.0) | 99 | 3.7–93.7 |
| Sexual abuse | 7 | 53.8 (24.4, 80.8) | 98 | 10.5–99.2 | 1 | NA | NA | NA | . . . | 11 | 39.8 (23.1, 59.3) | 98 | 10.5–99.2 |
| Discriminatione | 2 | NA | NA | NA | . . . | . . . | . . . | . . . | . . . | 4 | 47.5 (14.2, 83.2) | 99 | 15.5–79.8 |
| Unstable housingf | 16 | 31.7 (23.2, 41.7) | 95 | 4.9–72.7 | 2 | NA | NA | NA | . . . | 20 | 30.3 (23.1, 38.5) | 95 | 4.9–72.7 |
| Employment | 14 | 39.2 (29.4, 49.9) | 93 | 18.3–82.4 | 4 | 56.8 (35.8, 75.7) | 87 | 30.4–81.3 | .15 | 22 | 47.6 (37.4, 58.0) | 98 | 18.3–82.4 |
| Incarceration | 17 | 43.3 (31.2, 56.4) | 97 | 50.0–90.9 | 1 | NA | NA | NA | . . . | 18 | 41.3 (29.7, 54.0) | 97 | 5.0–90.9 |
| Health insurance | 6 | 71.9 (58.5, 82.3) | 95 | 46.7–85.8 | 4 | 70.1 (50.7, 84.3) | 64 | 52.5–78.3 | .87 | 12 | 72.3 (64.2, 79.1) | 93 | 46.7–85.8 |
Note. CI = confidence interval; I2% = the variation across studies that is attributable to heterogeneity rather than chance; κ = number of prevalence estimates used; min–max = minimum to maximum; NA = not applicable because < 3 studies reported for measure; PrEP = preexposure prophylaxis; STD = sexually transmitted disease; weighted % = weighted mean percentage.
Includes studies that did not differentiate between transwomen and transmen.
Test for between-group differences for transwomen and transmen.
Any ascertainment method (laboratory-confirmed and self-reported) for race estimates among transwomen only.
Meta-analysis of continuous measure.
Gender-based discrimination.
Includes homelessness.