HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub‐Saharan Africa: a systematic review and meta‐analysis

Abstract

Introduction: Developing effective targets, policies and services for key populations requires estimations of population sizes and HIV prevalence across countries and regions. We estimated the relative and absolute HIV prevalence among men who have sex with men (MSM), transgender women and men, and male and transgender sex workers (MSW and TGSW) in sub-Saharan African countries using peer-reviewed literature. Methods: We performed a systematic review of peer-reviewed studies assessing HIV prevalence in MSM, transgender women and men, MSW and TGSW in sub-Saharan Africa between 2010 and 2021, following PRISMA guidelines. We searched Embase, Medline Epub, Africa Index Medicus, Africa Journal Online, Web of Science and Google Scholar. We calculated HIV prevalence ratios (PRs) between the study prevalence, and the geospatial-, sex, time and age-matched general population prevalence. We extrapolated results for MSM and transgender women to estimate HIV prevalence and the number living with HIV for each country in sub-Saharan Africa using pooled review results, and regression approximations for countries with no peer-reviewed data. Results and discussion: We found 44 articles assessing HIV prevalence in MSM, 10 in transgender women, five in MSW and zero in transgender men and TGSW. Prevalence among MSM and transgender women was significantly higher compared to the general population: PRs of 11.3 [CI: 9.9-12.9] for MSM and 8.1 [CI: 6.9-9.6] for transgender women in Western and Central Africa, and, respectively, 1.9 [CI: 1.7-2.0] and 2.1 [CI: 1.9-2.4] in Eastern and Southern Africa. Prevalence among MSW was significantly higher in both Nigeria (PR: 12.4 [CI: 7.3-21.0]) and ). Extrapolating our findings for MSM and transgender women resulted in an estimated HIV prevalence of 15% or higher for about 60% of all sub-Saharan African countries for MSM, and for all but two countries for transgender women. Conclusions: HIV prevalence among MSM and transgender women throughout sub-Saharan Africa is alarmingly high. This high prevalence, coupled with the specific risks and vulnerabilities faced by these populations, highlights the urgent need for risk-group-tailored prevention and treatment interventions across the sub-continent. There is a clear gap in knowledge on HIV prevalence among transgender men, MSW and TGSW in sub-Saharan Africa.

Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

“…Stigma and discrimination remain important barriers to health equity. In sub-Saharan Africa, for example, HIV prevalence among MSM and transgender women is significantly higher than it is in the general population ( 18 ). Understanding the root causes including structural determinants of health for the observed differences and addressing potential factors leading to health disparities is essential to eliminate HIV as a global public health threat.…”

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

“…Sexual minorities include individuals who are attracted to or have sexual contact with people of the same gender and gender minorities include individuals whose gender identity or expression is different from their sex assigned at birth 5. In Western and Central Africa, the HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) is 11 times and 8 times that of the general adult population, respectively 6. In Eastern and Southern Africa, the prevalence among both MSM and TGW is 2 times the general adult prevalence 6.…”

“…5 In Western and Central Africa, the HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) is 11 times and 8 times that of the general adult population, respectively. 6 In Eastern and Southern Africa, the prevalence among both MSM and TGW is 2 times the general adult prevalence. 6 These statistics highlight the importance of understanding and addressing the vulnerability to HIV-related morbidity and mortality SGM in SSA face.…”

“… 6 In Eastern and Southern Africa, the prevalence among both MSM and TGW is 2 times the general adult prevalence. 6 These statistics highlight the importance of understanding and addressing the vulnerability to HIV-related morbidity and mortality SGM in SSA face. Robust HIV prevalence estimates among women who have sex with women (WSW) and transgender men (TGM) in SSA are severely limited 6–9 ; however, findings on the prevalence of HIV 10 11 and HIV risk behaviours 11 12 within these populations globally support the need for investigating the risks of HIV infection and barriers to HIV prevention and care services among WSW and TGM as well.…”

Urine tenofovir testing for real‐time PrEP adherence feedback: a qualitative study involving transgender women in Uganda

“…Transgender women (TGW), who are biologically assigned male at birth but identify as female, face a significant burden of HIV in East and Southern Africa. The reported prevalence of HIV among TGW in this region varies, ranging from 9.4% in Rwanda to 63.5% in South Africa [ 1 ]. In sub‐Saharan Africa, the standardized prevalence of HIV among TGW is estimated to be 29.9%, and TGW aged 15 or older have an overall odds ratio for HIV acquisition of 21.5 [ 2 ].…”