Correlates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia

Abstract

Purpose: In Malaysia, an estimated 9.7%-12.4% of transgender women (TW) are HIV positive, with higher estimates among those engaged in sex work. According to the 90-90-90 Joint United Nations Programme on HIV/AIDS strategy, HIV testing is the first crucial step in curbing the HIV epidemic. This study examines correlates of recent HIV testing among TW in Greater Kuala Lumpur, Malaysia. Methods: TW (N = 199) in Greater Kuala Lumpur completed a survey on healthcare access and utilization, including HIV testing history. Bivariate logistic regression and penalized multivariate logistic regression were used to explore correlates of HIV testing in the last 12 months. Results: Overall, 41.7% of TW reported having ever been tested for HIV. Among participants who were HIV negative or not sure of their HIV status (n = 187), only 18.7% (n = 35) had been tested for HIV in the last 12 months. The multivariate analysis indicated that having a primary care provider (PCP), being 26-40 years of age, and having higher mental health functioning were positively associated with recent HIV testing. Active amphetamine use and previous depression diagnosis were also associated with recent HIV testing. Conclusion: HIV testing is the first step in linking individuals to prevention and treatment interventions. Our findings suggest that having a PCP can improve engagement in HIV testing. Moreover, PCPs can serve as a valuable link to HIV treatment and prevention services. Current interventions that target social and behavioral risk factors for HIV, on their own, may be insufficient at engaging all HIV-vulnerable TW.

Intervening for HIV prevention and mental health: a review of global literature

“…In four studies, fewer symptoms of a mental disorder were associated with HIV or STI testing, and greater severity of symptoms was associated with less testing [74‐76]. HIV testing among TGW in Malaysia was associated with higher current scores of mental health functioning as well as having a previous diagnosis of depression [77]. In contrast, ever having a depressed mood for more than two weeks was independently associated with having an STI test in the past month among MSM in Burkina Faso [78].…”

“…In these cases, the negative effect of poor mental health may be mitigated by other factors that facilitate taking action (e.g. high perceived self-efficacy [60]), or poor mental health may enhance recognition of vulnerability and a need for support [77,89]. Evidence also showed that learning one's HIV status, whether negative or positive, did not worsen depressive symptoms or increase suicidality [79].…”

Understanding Women’s Knowledge, Awareness, and Perceptions of STIs/STDs in Asia: A Scoping Review

“…Notwithstanding the cohorts, women demonstrated a good degree of HIV/AIDS knowledge; however, the knowledge about other STIs/STDs was not very reassuring. Relative to female sex workers (FSWs), transgender women appear to have less KAP and awareness of pre-exposure prophylaxis (PrEP) [26,42,43]; despite PrEP's critical role in HIV prevention, especially for high-risk populations. Transgender women in Asia face discrimination and violence in healthcare settings, which is rooted in the region's profoundly traditional and patriarchal culture, which accentuates male dominance [26,43,44].…”

Current Research Involving LGBTQ People in Malaysia: A Scoping Review Informed by a Health Equity Lens

“…The higher prevalence found in Koh & Kamarulzaman's study could be due to its reliance on a clinical sample that captured LGBTQ people of higher risk profiles. The main factors that were found to associate with HIV risks were societal cisheterosexism, such as discrimination and violence, absence of education on safe sex, having multiple sex partners, poor mental health, substance abuse, and unprotected sex (Burch et al, 2018;Kanter et al, 2011;Koh & Yong, 2014;Lim, Brown, et al, 2020;Lim et al, 2015;Ng et al, 2020;Rutledge et al, 2018;Teh, 2008;Valentine et al, 2019).…”