HIV infection and STI in the trans population: A critical review

Background. - Based on the scarcity of existing data in France, the objective of this critical review of the literature is to assess the available data on HIV infection and STIs and their major risk factors among the transgender population around the world. Methods. - Papers published from 1986 to 2008 were selected in PubMed and Ovid using the following keywords in the title: "female-tomale", "male-to-female", "transsexualism", "Gender Identity Disorder", and the keywords "transsexualism", and "transgender". A second manual selection was carried out with the keywords "HIV", "AIDS", and "STI". A few non-indexed references were also included. Overall, 124 references were selected, most of them reporting studies in the United States. Results. - This review provides evidence of the difficulties related to establishing a consistent and consensual definition of the transgender population and its different subgroups and also to identifying its sociodemographic characteristics. It shows the diversity of risk factors and the risk for HIV infection and STIs, which endanger the different subgroups of this population to different degrees. Belonging to an ethnic minority, international migration, social instability, and participation in sex work are the major risk factors for this population. Taking into account that all transgender individuals are not exposed in the same proportions to HIV and STI risks, it is recommended that more social and epidemiological work be developed, which would more accurately consider all the characteristics of this population and the high-risk situations to which it is exposed. (C) 2011 Published by Elsevier Masson SAS.