The Situated Vulnerabilities and Resiliencies Framework: a call for integrated strategies to address global HIV inequities for transgender, non-binary, and gender diverse populations.

Abstract

Transgender, non-binary, and gender diverse (trans) populations are burdened by the risk of HIV acquisition. Achieving global UNAIDS 95-95-95 targets by 2030 among trans populations requires conceptual frameworks to understand HIV epidemic drivers and optimise effective strategies to curb HIV inequities in trans populations. The Situated Vulnerabilities and Resiliencies Framework describes and explains HIV inequities in these populations. The HIV epidemic among trans populations is situated in multilevel biopsychosocial contexts, and these populations are made vulnerable to HIV through fundamental causes and conditions that render them at risk for risk. Key considerations include pathways that are linked to sex and gender, all-population and trans-specific exposures, developmental context, syndemic dynamics, and intersectionality. The framework highlights the need to deploy integrated strategies and interventions that are neutral to HIV status and grounded in health and human rights, work with trans communities, and use strengths-based approaches leveraging situated resiliencies (ie, salutogenic factors such as collective agency and trans kinships) to reduce pervasive stigma and advance HIV equity in trans populations.