2010 - 2022年撒哈拉以南非洲地区跨性别群体及与男性发生性关系的顺性别男性中的艾滋病毒流行率：一项荟萃分析
HIV prevalence in transgender populations and cisgender men who have sex with men in sub-Saharan Africa 2010-2022: a meta-analysis.
作者信息
Stevens Oliver, Anderson Rebecca L, Sabin Keith, Garcia Sonia Arias, Fearon Elizabeth, Manda Kingsley, Dikobe Wame, Crowell Trevor A, Tally Leigh, Mulenga Lloyd, Philip Neena M, Maheu-Giroux Mathieu, McIntyre Anne, Hladik Wolfgang, Zhao Jinkou, Mahy Mary, Eaton Jeffrey W
机构信息
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland.
出版信息
medRxiv. 2023 Nov 9:2023.11.09.23298289. doi: 10.1101/2023.11.09.23298289.
INTRODUCTION
The Global AIDS Strategy 2021-2026 calls for equitable and equal access to HIV prevention and treatment programmes for all populations to reduce HIV incidence and end HIV/AIDS as a public health threat by 2030. Transgender populations (TGP), including transmen (TGM) and transwomen (TGW) are populations that have been marginalised and are at high risk of HIV infection in sub-Saharan Africa (SSA). Limited surveillance data on HIV among TGP are available in the region to guide programmatic responses and policymaking. Surveillance data on cisgender men who have sex with men (cis-MSM) are comparatively abundant and may be used to infer TGP HIV prevalence.
METHODS
Data from key population surveys conducted in SSA between 2010-2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both TGP and cis-MSM populations were analysed in a random effect meta-analysis to estimate the ratio of cis-MSM:TGW HIV prevalence.
RESULTS
Eighteen studies were identified encompassing 8,052 TGW and 19,492 cis-MSM. TGW HIV prevalence ranged from 0-71.6% and cis-MSM HIV prevalence from 0.14-55.7%. HIV prevalence in TGW was 50% higher than in cis-MSM (prevalence ratio (PR) 1.50 95% CI 1.26-1.79). TGW HIV prevalence was highly correlated with year/province-matched cis-MSM HIV prevalence (R = 0.62), but poorly correlated with year/province-matched total population HIV prevalence (R = 0.1). Five TGM HIV prevalence estimates were identified ranging from 1-24%. Insufficient TGM data were available to estimate cis-MSM:TGM HIV prevalence ratios.
CONCLUSION
Transgender women experience a significantly greater HIV burden than cis-MSM in SSA. Bio-behavioural surveys designed and powered to measure determinants of HIV infection, treatment coverage, and risk behaviours among transgender populations, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities among TGP and support improved programmes.
引言
《2021 - 2026年全球艾滋病战略》呼吁为所有人群提供公平平等的艾滋病毒预防和治疗方案，以降低艾滋病毒发病率，并在2030年前消除艾滋病毒/艾滋病作为公共卫生威胁。跨性别群体（TGP），包括男跨女（TGM）和女跨男（TGW），在撒哈拉以南非洲（SSA）是被边缘化且艾滋病毒感染风险很高的群体。该地区关于跨性别群体艾滋病毒的监测数据有限，难以指导项目应对措施和政策制定。与男同性恋者（cis - MSM）相关的监测数据相对丰富，可用于推断跨性别群体的艾滋病毒流行率。
方法
从现有数据库和调查报告中识别2010 - 2022年在撒哈拉以南非洲进行的重点人群调查数据。对收集了跨性别群体和男同性恋者艾滋病毒流行率的研究进行随机效应荟萃分析，以估计男同性恋者与女跨男艾滋病毒流行率的比值。
结果
共识别出18项研究，涵盖8052名女跨男和19492名男同性恋者。女跨男艾滋病毒流行率在0 - 71.6%之间，男同性恋者艾滋病毒流行率在0.14 - 55.7%之间。女跨男的艾滋病毒流行率比男同性恋者高50%（流行率比值（PR）1.50，95%置信区间1.26 - 1.79）。女跨男艾滋病毒流行率与年份/省份匹配的男同性恋者艾滋病毒流行率高度相关（R = 0.62），但与年份/省份匹配的总人口艾滋病毒流行率相关性较差（R = 0.1）。确定了5项男跨女艾滋病毒流行率估计值，范围在1 - 24%之间。现有男跨女数据不足，无法估计男同性恋者与男跨女艾滋病毒流行率比值。
结论
在撒哈拉以南非洲，女跨男面临的艾滋病毒负担明显高于男同性恋者。设计并具备足够能力以测量跨性别群体（与男同性恋者不同）中艾滋病毒感染决定因素、治疗覆盖率和风险行为的生物行为调查，将有助于更好地了解跨性别群体中的艾滋病毒风险和脆弱性，并支持改进相关项目。
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