Operario Don, Soma Toho, Underhill Kristen
Department of Social Policy and Social Work, University of Oxford, Oxford, UK.
J Acquir Immune Defic Syndr. 2008 May 1;48(1):97-103. doi: 10.1097/QAI.0b013e31816e3971.
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.
We conducted systematic searches of 6 electronic databases, and including studies that met pre-established criteria. We extracted data, appraised methodologic quality, assessed heterogeneity, and organized meta-analyses by comparison group.
We identified 25 studies among 6405 participants recruited from 14 countries. Overall crude HIV prevalence was 27.3% in TFSWs, 14.7% in transgender women not engaging in sex work, 15.1% in male sex workers, and 4.5% in female sex workers. Meta-analysis indicated that TFSWs experienced significantly higher risk for HIV infection in comparison to all other groups (relative risk [RR] = 1.46, 95% confidence interval [CI]: 1.02 to 2.09), and particularly in comparison to female sex workers (RR = 4.02, 95% CI: 1.60 to 10.11). We observed significant heterogeneity among the included studies, along with 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. Structural interventions to reduce reliance on sex work among transgender women may be warranted.
跨性别女性是感染艾滋病毒的主要风险群体，流行病学研究将该人群中艾滋病毒的高感染率归因于与性工作相关的行为。本系统评价比较了跨性别女性性工作者（TFSW）与不从事性工作的跨性别女性、男性性工作者及生理女性性工作者的艾滋病毒感染率。
我们对6个电子数据库进行了系统检索，纳入符合既定标准的研究。我们提取数据、评估方法学质量、评估异质性，并按比较组进行荟萃分析。
我们从14个国家招募的6405名参与者中确定了25项研究。总体而言，TFSW的艾滋病毒粗感染率为27.3%，不从事性工作的跨性别女性为14.7%，男性性工作者为15.1%，女性性工作者为4.5%。荟萃分析表明，与所有其他组相比，TFSW感染艾滋病毒的风险显著更高（相对风险[RR]=1.46，95%置信区间[CI]：1.02至2.09），特别是与女性性工作者相比（RR=4.02，95%CI：1.60至10.11）。我们在所纳入的研究中观察到显著的异质性，同时存在方法学局限性以及性工作和性别的定义不精确的问题。
TFSW可受益于有针对性的艾滋病毒预防干预措施、艾滋病毒检测以及有助于降低感染或传播艾滋病毒风险的干预措施。可能有必要采取结构性干预措施，以减少跨性别女性对性工作的依赖。
