Transgender women and transfeminine people living with HIV face a disproportionate burden of mental health and substance use challenges, with pooled prevalence estimates of 40% for depressive symptoms, 29% for suicidal ideation, 26% for suicide attempt, and 50% for gender discrimination, highlighting the crucial need for integrated HIV care models incorporating routine mental health screening with culturally affirming and trauma-informed interventions.
The pooled prevalence of depressive symptoms among transgender women and transfeminine people living with HIV was 40%.
The pooled prevalence of suicidal ideation was 29% and suicide attempt was 26% among transgender women and transfeminine people living with HIV.
The pooled prevalence of anxiety symptoms was 39% and PTSD symptoms was 33% among transgender women and transfeminine people living with HIV.
The pooled prevalence of gender discrimination was 50% among transgender women and transfeminine people living with HIV.
Substance use was highly prevalent in this population, with tobacco use at 61% and methamphetamine use at 38%.
Alcohol use was common, with any alcohol use at 40%, hazardous alcohol use at 31%, and binge drinking at 25%.
The majority of included studies were conducted in the Americas, with a substantial concentration in the USA.
The authors found that integrated HIV care models incorporating routine mental health screening with culturally affirming and trauma-informed interventions are needed.
This research synthesized data from 63 studies involving over 8,000 transgender women and transfeminine people living with HIV to understand how common mental health problems and substance use are in this group. The findings reveal extremely high rates across nearly every mental health outcome measured: about 4 in 10 experienced depression or anxiety symptoms, about 1 in 3 had symptoms of PTSD or had attempted suicide, and half reported experiencing gender discrimination. Substance use was also widespread, with nearly two-thirds reporting tobacco use and more than one-third reporting methamphetamine use. This research suggests that transgender women and transfeminine people living with HIV carry an exceptionally heavy burden of mental health challenges, likely compounded by the stigma and discrimination they face both as transgender individuals and as people living with HIV. The study also highlights a significant gap in global research, as nearly 90% of the studies came from the Americas and more than half from the United States alone, meaning little is known about experiences in other parts of the world. The findings point to a critical need for HIV treatment programs to routinely screen for mental health conditions and to offer care that is specifically designed to be respectful of transgender identities and sensitive to trauma. The authors also emphasize that addressing the broader social and structural conditions—such as discrimination and lack of access to affirming healthcare—is essential to improving both mental health and HIV-related outcomes for this population.
Coelho D, Defante M, da Silva Sanglard R, Mendes B, Vieira W, Wade C, et al.. (2026). Global mental health disparities among transgender women and transfeminine people living with HIV: a systematic review and meta-analysis of 63 studies.. The lancet. HIV. https://doi.org/10.1016/S2352-3018(26)00004-4