HIV prevalence and factors associated with HIV infection among transgender women in Cambodia: results from a national Integrated Biological and Behavioral Survey

Abstract

ObjectiveTo examine factors associated with HIV infection among transgender women in Cambodia.DesignCross-sectional study.SettingsHIV high-burden sites including the capital city and 12 provinces.ParticipantsThis study included 1375 sexually active transgender women with a mean age of 25.9 years (SD 7.1), recruited by using respondent-driven sampling for structured questionnaire interviews and rapid finger-prick HIV testing.Primary outcome measureHIV infection detected by using Determine antibody test.ResultsHIV prevalence among this population was 5.9%. After adjustment for other covariates, participants living in urban areas were twice as likely to be HIV infected as those living in rural areas. Participants with primary education were 1.7 times as likely to be infected compared with those with high school education. HIV infection increased with age; compared with those aged 18–24 years, the odds of being HIV infected were twice as high among transgender women aged 25–34 years and 2.8 times higher among those aged ≥35 years. Self-injection of gender affirming hormones was associated with a fourfold increase in the odds of HIV infection. A history of genital sores over the previous 12 months increased the odds of HIV infection by threefold. Transgender women with stronger feminine identity, dressing as a woman all the time, were twice as likely to be HIV infected compared with those who did not dress as a woman all the time. Having never used online services developed for transgender women in the past six months was also associated with higher odds of being HIV infected.ConclusionsTransgender women in Cambodia are at high risk of HIV. To achieve the goal of eliminating HIV in Cambodia, effective combination prevention strategies addressing the above risk factors among transgender women should be strengthened.

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

“…Although greater than 5% of transgender youth age 18 to 24 years were already HIV positive, acquisition of infection appeared to rapidly accelerate to 3.5‐fold by the late 20s and early 30s. This finding is similar to those of studies in Cambodia and Thailand and consistent with a cumulative probability of being exposed to HIV over the life course . The particularly steep rise in HIV prevalence from 25 to 35 may point to a critical period to intervene vigorously with behavioural and biological interventions, such as those being delivered by the “China AIDS Fund for Non‐Governmental Organization” (CAFNGO) .…”

“…Not surprising, history of STI diagnosis was associated with HIV infection, consistent with transgender health research worldwide and with the common sexual mode of transmission. The prevalence of STI may be under‐reported considering the context of the question was having a recent diagnosis, many infections being asymptomatic, and potential under‐recognition of pharyngeal and rectal sites of infection by respondents and clinicians.…”

“…Even in sub‐Saharan Africa, the region of the world with the highest burden of HIV infection among the general population, transgender women have significantly higher HIV prevalence . In the few Asian countries with data on transgender women, surveys have also demonstrated high prevalence of HIV, for example, in Indonesia (26.1%), Thailand (12.5%), Vietnam (18.0%) and Cambodia (5.7%) .…”

“…In the United States and Peru , race, multiple sexual partners, condomless receptive anal or vaginal sex, non‐prescribed injection of hormones or drugs, sharing drug paraphernalia, engaging in commercial sex work and history of sexually transmitted infections (STI) were associated with HIV . In Southeast Asia, age, alcohol use, amphetamine use, sex with male sex workers and dressing as a woman all the time were risk factors for HIV . However, data on HIV prevalence and correlates of HIV infection among transgender women in China are scant.…”

Simulated Vaccine Efficacy Trials to Estimate HIV Incidence for Actual Vaccine Clinical Trials in Key Populations in Uganda

“…The proportions of each of male sex, those aged over 25 years, with formal education, and having lived in the community for over one year were higher in the SiVET cohort than in the non-SiVET cohort. These participant characteristics have been previously associated with lower risk of HIV acquisition in these populations [8,11,13,25] and other HIV at-risk populations [26][27][28][29]. The selection difference between trials and source population have been previously highlighted [14,17].…”