Decentralizing HIV Testing for Transgender Populations in India: Evidence from Community Platforms and Facility-Based Models
1
Programme, Plan International (India Chapter), Delhi, India
Popul. Med. 2026;8(Supplement Supplement 1):A717
ABSTRACT
BACKGROUND:
HIV prevalence among transgender (TG) populations remains disproportionately high at 3.78% (HSS 2021). Structural stigma, identity-related marginalization, unstable livelihoods and limited access to sexual and reproductive health (SRH) services continue to impede timely HIV testing and diagnosis. Plan India, is implementing community-led, decentralized HIV testing through integrated and differentiated service delivery models across 13 states.
METHODS:
The project is guided by three
OBJECTIVES:
(i) expanding HIV testing to reach unreached and newly identified TGs; (ii) creating an enabling environment to reduce stigma and discrimination; and (iii) strengthening community empowerment through awareness and social protection linkages. HIV testing is delivered through facility-based services and decentralized platforms.
RESULTS:
A total of 10,912 TGs were registered, of whom 68.4% were aged below 30 years. Compared to decentralized platforms, facility-registered TGs had 38% higher odds of being under 30 years (OR = 1.38; 95% CI: 1.26–1.53; p < 0.001). Facility registrants were 2.27 times more likely to have higher education (higher secondary or above) compared to those reached through outreach platforms (OR = 2.27; 95% CI: 2.08–2.53; p < 0.001), and 2.2 times more likely to be students or salaried employees rather than unemployed, self-employed or daily-wage earners (OR = 2.27; 95% CI: 1.96–2.70; p < 0.001). HIV positivity remained higher among facility-registered TGs (6.25%) compared to those reached through decentralized platforms (3.33%). Facility registrants had 1.94 times higher odds of being newly HIV positive compared to those reached through outreach (OR = 1.94; 95% CI: 1.59–2.37; p < 0.001).
CONCLUSIONS:
Decentralized, community-led HIV testing platforms complement facility-based services by reaching older, less educated and economically marginalized TG populations who face barriers to accessing formal healthcare. Integrating decentralized testing into national HIV strategies is essential to scale up testing uptake and accelerate progress towards the 95–95–95 targets.
HIV prevalence among transgender (TG) populations remains disproportionately high at 3.78% (HSS 2021). Structural stigma, identity-related marginalization, unstable livelihoods and limited access to sexual and reproductive health (SRH) services continue to impede timely HIV testing and diagnosis. Plan India, is implementing community-led, decentralized HIV testing through integrated and differentiated service delivery models across 13 states.
METHODS:
The project is guided by three
OBJECTIVES:
(i) expanding HIV testing to reach unreached and newly identified TGs; (ii) creating an enabling environment to reduce stigma and discrimination; and (iii) strengthening community empowerment through awareness and social protection linkages. HIV testing is delivered through facility-based services and decentralized platforms.
RESULTS:
A total of 10,912 TGs were registered, of whom 68.4% were aged below 30 years. Compared to decentralized platforms, facility-registered TGs had 38% higher odds of being under 30 years (OR = 1.38; 95% CI: 1.26–1.53; p < 0.001). Facility registrants were 2.27 times more likely to have higher education (higher secondary or above) compared to those reached through outreach platforms (OR = 2.27; 95% CI: 2.08–2.53; p < 0.001), and 2.2 times more likely to be students or salaried employees rather than unemployed, self-employed or daily-wage earners (OR = 2.27; 95% CI: 1.96–2.70; p < 0.001). HIV positivity remained higher among facility-registered TGs (6.25%) compared to those reached through decentralized platforms (3.33%). Facility registrants had 1.94 times higher odds of being newly HIV positive compared to those reached through outreach (OR = 1.94; 95% CI: 1.59–2.37; p < 0.001).
CONCLUSIONS:
Decentralized, community-led HIV testing platforms complement facility-based services by reaching older, less educated and economically marginalized TG populations who face barriers to accessing formal healthcare. Integrating decentralized testing into national HIV strategies is essential to scale up testing uptake and accelerate progress towards the 95–95–95 targets.
| eISSN: | 2654-1459 |
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