HIV Prevalence and Risks Associated with HIV Infection among Transgender Individuals in Cambodia

Abstract

IntroductionRecognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia.MethodsCross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited.ResultsThe majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20–27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35–44 and adjusted OR = 7.63 [2.55, 22.81] for age 30–34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37,23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09,7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR = 3.25 [1.35,7.85]) were independently associated with HIV infection.ConclusionsThis study confirms transgender individuals as one of the highest-risk groups for HIV infection in Cambodia. It suggests the need for programmatic strategies that mitigate identified associated risks and facilitate access to HIV care for this population.

HIV prevalence, risky behaviors, and discrimination experiences among transgender women in Cambodia: descriptive findings from a national integrated biological and behavioral survey

“…The HIV prevalence found in our study is slightly higher than the 4.2% found by a recent study by Weissman et al [17], but both are significantly higher than an earlier study conducted in 2010 which found a prevalence of 2.6% among transgender women [18]. However, direct comparison of findings from this study with those in the previous ones is difficult because of the differences in characteristics of the samples and measures.…”

Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil

“…20 Substance use before or during sex was previously shown to be an independent predictor of condomless receptive anal sex in transwomen. 21,22 …”

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

“…As a result, their unique needs were not reflected in HIV programmes’ goals. 22 There was also a lack of transgender women-specific data to quantify the number reached by outreach programmes and services. In 2012, the first Integrated Biological and Behavioral Survey (IBBS) that specifically included transgender women in Cambodia found an HIV prevalence of 4.2% among this population, 22 which was six times higher than the 0.7% prevalence among the general adult population aged 15–45 years, 23 and about twice higher than the 2.1% among MSM.…”

“… 22 There was also a lack of transgender women-specific data to quantify the number reached by outreach programmes and services. In 2012, the first Integrated Biological and Behavioral Survey (IBBS) that specifically included transgender women in Cambodia found an HIV prevalence of 4.2% among this population, 22 which was six times higher than the 0.7% prevalence among the general adult population aged 15–45 years, 23 and about twice higher than the 2.1% among MSM. 24 This 2012 study also found that older age (>35 years), residing in Siem Reap province (a major tourist site), having sex during or after drug use, not using a condom during the last anal sex and low self-esteem were associated with HIV infection among transgender women.…”