About one in five transgender women worldwide are living with HIV, according to a major new study by Johns Hopkins researcher Dr. Stefan Baral and his colleagues. The study also found that transgender women are in urgent need of HIV prevention, treatment, and care services.
The research team conducted a meta-analysis, which combined data from 39 studies involving more than 11,000 transgender women in 15 countries. Their review of the research literature from 2000 through 2011 found that data on the HIV prevalence among transgender women were available only in countries with male-predominant HIV epidemics, including the US, six countries in the Asian-Pacific region, five in Latin America, and three in Europe.
Overall, about one-fifth (19%) of the transgender women studied were living with HIV. The calculated HIV prevalence rate was somewhat higher for transgender women in five high-income countries (21.6%) than the rate found in ten low- and middle-income countries (17.7%). The researchers noted, however, that transgender women in all the countries studied had HIV prevalence rates roughly 50 times greater than that of other adults of reproductive age.
"In view of the limited worldwide data for transgender women and extraordinary disease burdens we have identified, the present HIV surveillance and prevention interventions for transgender women are clearly inadequate," the research team noted. "The high burden of HIV is probably a function of both low coverage rates for effective interventions, and an insufficient range of interventions to reduce HIV infection risks for this population. Transgender-specific interventions are scarce, and no randomized trials of prevention technologies have included sufficient transgender participants to assess efficacy for these people."
In addition, "Structural change will also be essential," according to the researchers. "Transgender women and communities are emerging and advocating for their rights as citizens, and their full inclusion in the HIV response. The sexual orientation and gender identity strategy of the Global Fund is a welcome example of expanding efforts at such inclusion. Removing gender dysphoria/gender identity disorder from . . . the 11th International Classification of Diseases could provide support for increased visibility of transgender people with less fear of being automatically labeled mentally ill. Greater visibility should be coupled with transgender people and communities having a stronger voice." The researchers also recommended that transgender persons be specifically counted in national HIV surveillance programs and in HIV-focused research studies, rather than lumping data for transgender women with that for men who have sex with men.
Potential impact of automatic federal budget cuts could be devastating to people living with HIV/AIDS
"Applying sequestration cuts to domestic HIV/AIDS programming would provide negligible deficit reduction, but would have a devastating impact on people living with HIV/AIDS (PLWHA) in America," according to a recent assessment by The Foundation for AIDS Research (amfAR) and NMAC. "It would also damage American leadership in health research, and limit the United States' ability to reduce the rate of new HIV infections, improve access to care, and reduce the disproportionate impact of HIV/AIDS on communities of color."
Sequestration Background: Under the Budget Control Act of 2011, the U.S. Congress was tasked with reducing the federal deficit by $1.2 trillion over the next decade. Under that Act, failure to propose a plan to reduce the deficit by the agreed-upon deadline would trigger an enforcement mechanism resulting in automatic budget cuts in both defense and non-defense spending. This enforcement mechanism is called "sequestration." The fiscal cliff deal reached by Congress in January delayed the start of sequestration from January 2 to March 1, 2013. Unless Congress acts to avert sequestration, automatic budget cuts amounting to 5.2% of non-defense discretionary spending will kick in during March. To calculate the impact of sequestration on HIV/AIDS programs, amfAR and NMAC drew on figures from the Center on Budget and Policy Priorities. These projected impacts are summarized below, along with selected commentary (in quotes) by amfAR and NMAC:
AIDS Drug Assistance Program (ADAP): As a result of sequestration cuts, an estimated 9,750 HIV-infected persons – including over 6,500 persons of color – would lose access to the ADAP, which provides antiretroviral medications to low-income PLWHA. The loss of access to HIV treatment would also hamper efforts to reduce HIV transmission: "Recent research has shown that, in addition to saving and improving the lives of PLWHA, HIV treatment reduces the risk of transmitting HIV to an uninfected partner by 96%."
Housing Opportunities for Persons with AIDS Program (HOPWA): If sequestration cuts to HOPWA take effect, an estimated 1,300 fewer households would receive permanent housing and 1,800 fewer households would receive short-term assistance to prevent homelessness. The impact of the HOPWA cuts would be especially heavy on HIV-infected persons of color. NMAC and amfAR estimate that 1,850 households that include at least one person of color would lose HOPWA housing services; 560 households that include at least one Hispanic person would lose housing services.
AIDS Research Funding: The National Institutes of Health are projected to lose $157 million in AIDS research funding if sequestration cuts occur. As a result, an estimated 290 AIDS research grants would go unfunded, including 30 specifically funding AIDS vaccine research.
CDC Funding for State and Local HIV Prevention Efforts: Under sequestration, more than $40 million in CDC funding would be cut from state and local HIV prevention efforts, including programs targeting young people and adults at high risk of infection.
If the US Congress is able to reach budget agreement to avoid sequestration, we plan to report on the agreement in an upcoming issue of the Health Disparities Update.
Eric Brus is the Director of HIV Health Promotion of AIDS Action Committee. This report is produced by the Health Library of the AIDS Action Committee in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online, www.aac.org