LAUSR

Our knowledge about HIV among transgender populations has substantially improved since the Journal of the International AIDS Society (JIAS) published its first special issue about HIV in transgender populations in 2016 [1]. A PubMed search indicates that more than 1000 peer-reviewed manuscripts focused on HIV among transgender people have been published in the past 5 years. While this increased volume of research is heartening, the findings indicate transgender people remain disproportionately burdened by HIV globally. A recent meta-analysis of studies published between 2000 and 2019 found an overall HIV prevalence of 19.9% for trans feminine individuals and 2.6% for trans masculine individuals with odds ratios of 66 and 7, respectively, compared to all individuals ages 15 years and older [2]. While data on the HIV prevention and care continuum among transgender people are limited, existing studies indicate lower engagement in HIV testing, pre-exposure prophylaxis (PrEP) uptake, persistence and adherence, as well as antiretroviral therapy (ART) uptake and adherence [3]. These appalling inequities in HIV prevalence, prevention and care are driven by socio-structural factors rooted in stigma and discrimination [4]. In keeping with the most recent World AIDS Day call to “end inequalities” as well as the AIDS 2022, the 24th International AIDS Conference theme, “re-engage and follow the science,” we dedicated this special issue to research that fills important gaps in science and provides data that can be used to end inequities in HIV prevention and care for transgender people. We called for abstracts that fill gaps in knowledge about trans masculine people, gender non-binary people, transgender people in sub-Saharan Africa, as well as data on community-based and clinical interventions. Manuscripts by transgender authors were encouraged. We were excited to receive more than 70 abstracts. Through a careful process of editorial and peer review, we selected 13 quality manuscripts that contribute to the evidence base for advancing equity for transgender people in the HIV response. This issue includes research from countries across the globe, including rare data focused on transgender people in sub-Saharan Africa; studies inclusive of and/or focused specifically on transgender men; and programmatic data that provide practical insights into potentially effective strategies to engage transgender people in HIV prevention and care. We are delighted that more than half of the manuscripts in this special issue are led or coauthored by transgender and nonbinary people. We include two manuscripts that address some of the extensive gaps in HIV research focused specifically on the experiences and needs of transgender men. Radix et al. provide one of the largest clinical data sets on HIV prevalence and sexual risk among transgender men in the United States. Data from this relatively diverse sample of 577 transgender men found that White participants were less likely to be tested for HIV, Black participants were more likely to be living with laboratory-confirmed HIV and HIV prevalence was highest for transgender men who reported having only cisgender male partners [5]. In multivariable analyses, race was no longer significantly associated with HIV status; however, participants with only cisgender male partners had a statistical odds of living with HIV that was 10-fold higher than those without a cisgender male partner. The authors underscore the need to collect better data on sexual practices among transgender men, particularly those who have sex with cisgender men, in order to include them in HIV prevention efforts for men who have sex with men (MSM) and to develop culturally and anatomically appropriate educational materials for them. Appenroth and colleagues directly compare self-reported sexual health outcomes of 122 transgender MSM with more than 22,000 cisgender MSM in Germany [6]. In their study, transgender MSM were less likely to self-report living with HIV but were also less likely to report receiving an HIV test result, suggesting that some transgender MSM may be living with HIV but are unaware because they have not been tested. Transgender MSM were less likely than cisgender MSM to