- High prevalence of stigma, physical and sexual violence, anxiety, depression, and suicidality that obstruct access to HIV and gender-affirming healthcare.
- Condomless receptive anal intercourse and low HIV testing, especially among sex workers, driven by coercion, perceived low risk and fear of disclosure.
- Urgent need for trans-specific interventions and longitudinal research to reduce HIV incidence, improve mental health, and remove structural barriers to care.
J Int AIDS Soc. 2026 Sep;29(9):e70206. doi: 10.1002/jia2.70206.
ABSTRACT
INTRODUCTION: This scoping review aimed to characterize the prevalence and determinants of HIV acquisition among transgender women in Southwest Asia and North Africa (SWANA), to describe HIV preventive activities and measures, and to examine barriers to HIV and gender-affirming care, including experiences of stigma, discrimination and mental health challenges among transgender women in the region.
METHODS: We searched PubMed, PsycINFO and CINAHL for any articles published through 12 June 2026, that included transgender women, used primary or secondary data and were published in Arabic or English. Studies meeting these criteria were screened in Covidence. Discrepancies were resolved following data extraction.
RESULTS: A total of 276 articles were identified (152 duplicates removed). After screening titles and abstracts, 49 full texts were assessed for eligibility. The articles included (N = 23) were primarily cross-sectional studies (N = 20) conducted in Iran, Lebanon, Turkey, Morocco and Tunisia. Three were non-randomized experimental studies; one intervention was designed specifically for transgender women, focusing on gender affirmation and social support. Cross-sectional studies examined HIV prevention, sexual activities and mental health. Condomless receptive anal intercourse and low HIV testing rates were most common among those engaged in sex work, which was attributed to coercion, perceived low risk for HIV acquisition or fear of disclosing one’s HIV status. Stigma, physical and sexual violence, anxiety, depression and suicidality were highly prevalent among transgender women in SWANA and served as barriers to accessing healthcare services, including HIV and gender-affirming care.
DISCUSSION: This review highlights critical areas for trans-specific interventions addressing transgender women’s needs in SWANA, where HIV incidence remains on the rise.
CONCLUSIONS: Future longitudinal research is needed to evaluate the effectiveness of interventions in reducing HIV rates, improving mental health outcomes and mitigating structural barriers hindering healthcare access among transgender women in SWANA.
PMID:42758513 | DOI:10.1002/jia2.70206
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