- Sexual violence is significantly associated with higher HIV odds among sexual and gender minorities in low-resource settings (pooled OR 2.05, 95% CI 1.71-2.47).
- The association was stronger for transgender women (OR 3.14) than cisgender MSM (OR 1.84); gender identity explained heterogeneity.
- Significant publication bias observed; trim-and-fill adjusted pooled OR 1.73. Evidence mainly from TW and cis-MSM; findings not generalisable to WSW.
Public Health. 2026 Sep 5;259:106488. doi: 10.1016/j.puhe.2026.106488. Online ahead of print.
ABSTRACT
OBJECTIVES: Sexual violence has been reported to correlate with HIV infection among Sexual and gender minorities, yet evidence regarding the association between sexual violence and HIV infection within this population in low-resource settings remains limited. This meta-analysis aimed to quantify the pooled association and explore subgroup disparities.
STUDY DESIGN: Systematic review and meta-analysis of observational studies following PRISMA 2020.
METHODS: Registered on PROSPERO (CRD420261398499). We searched eight databases up to April 7, 2026. Random-effects models were used to pool odds ratios; subgroup analyses, univariate meta-regression, sensitivity analyses, trim-and-fill, Egger’s and Begg’s tests were performed. The AHRQ/NOS tool was applied to assess study quality.
RESULTS: A total of 21 eligible observational studies were included. Only one small-sample study enrolled women who have sex with women (WSW), and the majority of evidence came from transgender women (TW) and cis-gender men who have sex with men (MSM).Sexual violence was significantly associated with elevated odds of HIV infection (pooled OR = 2.05, 95% CI: 1.71-2.47, I2 = 57.4%). The magnitude of this observed association was stronger among TW (OR = 3.14) compared with cisgender MSM (OR = 1.84). Univariate meta-regression identified gender identity as the primary detectable source of between-study heterogeneity. Significant publication bias was detected; the trim-and-fill adjusted pooled OR was 1.73.
CONCLUSIONS: We observed a significant association between sexual violence and elevated odds of HIV infection among Sexual and gender minorities in low-resource contexts, with TW showing the strongest association. These findings underscore the need for trauma-informed multi-level strategies targeting sexual violence and HIV-related health disparities in this population. Notably, evidence was predominantly generated from TW and cis-MSM, with only one small study among WSW; our findings cannot be generalized to WSW.
PMID:42700700 | DOI:10.1016/j.puhe.2026.106488
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