A MAJOR Australian cohort study has found that HIV incidence among transgender people fell by almost 94% between 2014 and 2023.
The findings, drawn from 10 years of health record data, suggest substantial progress in HIV prevention but ongoing challenges for sexually transmitted infection (STI) control within transgender populations.
The study describes HIV incidence among transgender people as decreasing from 1.19 per 100 person-years in 2014 to 0.07 per 100 person-years in 2023. However, overall STI burden has not followed the same trajectory.
Transgender HIV Incidence in Context
Transgender people have historically been underrepresented in HIV and STI surveillance in Australia, despite recognition by the World Health Organisation as a key population in prevention efforts.
Until recently, Australian HIV strategy documents made little reference to transgender communities, contributing to gaps in epidemiological understanding and policy planning.
The study cohort included 7,284 transgender people, alongside two cisgender comparison groups comprising gay and bisexual men and heterosexual individuals. The authors note that the comparative groups were limited to men and heterosexual populations due to the structure of existing surveillance datasets, which may restrict broader population comparisons.
Cohort Data Reveals Uneven STI Patterns
Incidence of other STIs remained largely stable across the study period. Chlamydia, gonorrhoea and syphilis rates showed persistent transmission patterns, with gonorrhoea highest in anorectal and pharyngeal sites. These anatomical differences highlight the need for more nuanced clinical screening approaches in transgender care pathways.
Pre-exposure prophylaxis (PrEP) use increased over time, rising from 18.8% in 2016 to 30.2% in 2023 among transgender participants. While PrEP was associated with reduced HIV incidence, it was also linked with higher detection of other STIs, reflecting continued exposure risk and potentially improved testing uptake.
Surveillance Gaps and Future Priorities
The study highlights ongoing limitations in Australian surveillance systems, including difficulties in accurately capturing transgender identities in electronic records. Misclassification risks and inconsistent coding may contribute to under-reporting and uncertainty in national estimates.
The authors emphasise that strengthening HIV and STI policy, alongside improved surveillance and targeted prevention strategies, will be essential to sustain progress. Wider efforts to improve education about transgender health and ensure respectful, person-centred care may also support more effective engagement with services.
Reference
Callander D et al. Trends in incidence of HIV and other sexually transmissible infections among transgender people in Australia: a retrospective 10-year national clinical cohort study. Lancet HIV. 2026;DOI:10.1016/S2352-3018(26)00010-X.
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