Sexually transmitted and blood-borne infections in transgender and non-binary people in Canada: A scoping review

In the 2021 census, 100,815 people in Canada aged 15 and older identified as transgender or non-binary. Globally, transgender people are disproportionately burdened by several Sexually Transmitted and Blood-Borne Infections (STBBIs) but limited data are available in Canada. Transgender and non-binary people are recognised as key populations in the STBBI Action Plan 2024-2030. We conducted a scoping review of the evidence relating to STBBI prevalence; risk exposures; and use of STBBI testing, treatment and prevention services among transgender and non-binary people in Canada. We searched six databases for articles published between January 1, 2013 and September 1, 2023 and conducted a grey literature search of information published on provincial and territorial public health department websites and websites of eight relevant community organisations. 26 of 934 screened records were included, of which five were provincial surveillance reports from Ontario and Quebec. It is difficult to quantify the prevalence of any STBBI among transgender and non-binary people in Canada. Most provinces and territories, and the federal government, do not publish disaggregated STBBI prevalence data for these populations. Peer-reviewed literature provides HIV prevalence data for several subgroups of the transgender population in some parts of Canada but, in general, these studies were not designed to produce valid prevalence estimates. Transgender people may be less sexually active than other population groups, though this may vary between subgroups of the transgender population. Transgender people face many barriers to accessing healthcare, testing and treatment for STBBIs, while almost no research has been conducted on STBBIs in non-binary people. It is not possible to make specific recommendations for public policy based on the evidence as it currently exists. More public health surveillance and research, conducted in collaboration with transgender and non-binary communities across Canada, would help to better understand the burden of STBBIs in these populations nationally.