HIV Testing Among Transgender and Other Gender-Diverse Persons in the United States: A Scoping Review

An overview of existing research on HIV testing among transgender and other gender-diverse (TGD) populations in the United States, critical for developing effective future interventions and research, is missing.

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 3 databases (CINAHL, PubMed/Medline, PsycINFO) were searched for studies reporting in English on HIV testing behavior that focused on or included TGD persons, published in the past decade (February 2, 2013 to February 2, 2023). Twenty-six studies were included and extracted using Covidence.

Four themes regarding HIV testing among TGD persons were identified: prevalence of HIV testing compared with cisgender persons, testing frequency and associated factors among TGD persons, barriers and facilitators to HIV testing experienced by TGD persons, and testing modalities. TGD persons seemed more likely to have been tested for HIV than cisgender persons, but less frequent than cisgender men who have sex with men. Barriers to testing included availability, confidentiality concerns, and negative interactions with providers. Social support and gender-affirming care were seen as facilitators. Self-testing, although not common, was acceptable and preferred when available. The conceptualizations and operationalizations of the term transgender varied markedly across studies.

Our understanding of HIV testing practices in TGD populations is limited and shows serious gaps. Research on repeat testing is needed to enhance HIV prevention and care among TGD populations. Future research might benefit from theory-driven approaches and from involving TGD persons in the design and implementation of studies to ensure relevance and efficacy.