Toward leaving no one behind: HIV infection among trans communities in Kazakhstan.

Abstract

Background: Central Asia, and Kazakhstan in particular, is virtually absent from global transgender (trans) Human Immunodeficiency Virus (HIV) research, despite evidence of disproportionate barriers to care. This absence erases local realities, weakens the evidence base, and renders communities invisible in policy. While global studies highlight trans people's heightened vulnerability to HIV and sexually transmitted infections (STIs) due to stigma, limited access, and scarce affirming services, little epidemiological data from Central Asia exists. This study addresses that absence by examining both known and newly detected infection prevalence among trans participants in Kazakhstan, underscoring the need to center trans health in the pursuit of collective trans liberation.

Aims: Generate the first empirical data on HIV risk, prevention engagement, and structural determinants among trans people in Kazakhstan, situating findings within regional and global commitments to leaving no one behind in health.

Methods: Analysis of HIV and STI prevalence among 68 trans participants in Almaty, Astana, and Shymkent (2018-2022), drawing on behavioral and biological data from a National Institute on Drug Abuse-funded prevention trial for substance-using cisgender (cis) and trans gay and bisexual men who have sex with men.

Results: Most participants (69%) had tested for HIV at least once, 32% in the past six months; however, 37% did not know their current status. Fourteen (21%) were confirmed HIV-positive, 79% previously unaware. Nearly half tested positive for at least one STI, with 10% for multiple.

Discussion: Findings reveal high HIV and STI burdens and critical gaps between self-reported awareness and confirmed diagnoses. Testing rates fall below UNAIDS 95-95-95 targets, highlighting the urgent need for expanded testing, research, and community-led interventions. Making these realities visible is essential for improving health in Kazakhstan and advancing collective trans liberation worldwide; without centering trans experiences, the global struggle for trans health and rights remains incomplete and the principle of leaving no one behind unfulfilled.