Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China

Abstract

IntroductionGlobally, transgender women sex workers have a high prevalence of HIV and condomless receptive anal intercourse with male clients (CRAIMC). We investigated the prevalence of CRAIMC and factors associated with CRAIMC among transgender women sex workers in China.MethodsIn 2014, we anonymously interviewed 220 transgender women sex workers face to face in Shenyang, China. Those who self-reported as HIV negative or as having unknown HIV serostatus were invited to take up free, anonymous HIV rapid testing (n=183); 90 did so. Using CRAIMC in the last month as the dependent variable, three types of associated factors were investigated, in addition to background factors: feminizing medical interventions, sex work and perceptions related to condom use. Univariate and multiple logistic regression models were fitted.ResultsOf the participants, 16.8% self-reported as HIV positive and 9.1% were detected to be HIV positive through free HIV testing; 26.8% had had CRAIMC in the last month, 45.5% had performed sex work in other Chinese cities (last year), and 23.2% had had condomless anal intercourse with men who were non-clients. In the adjusted analysis, significant factors associated with CRAIMC (last month) included the following: 1) any feminizing medical intervention performed (adjusted odds ratio, AOR: 2.22); 2) sex-work-related factors, including recruitment of male clients most often at hotels (AOR: 5.02) and charge per episode of transactional sex (201 to 400 RMB, AOR: 0.27; reference group: ≤100 RMB); and 3) perceptions related to condom use, including perceived transgender identity's impact on condomless sex such as wearing feminine attire, concern about exposing their status as a transgender woman to male clients (AOR: 1.20) and perceived self-efficacy of consistent condom use with male clients (AOR: 0.56). Perceived self-efficacy of consistent condom use with male clients fully mediated the association between perceived transgender identity's impact on condomless sex and CRAIMC.ConclusionsHIV prevalence among transgender women sex workers was high but probably underestimated. The high prevalence of condomless anal intercourse with male non-clients and high mobility in sex work among this population in China are causes for concern. Risk factors for CRAIMC were multidimensional and should be considered when designing interventions targeting transgender women sex workers. Such interventions are urgently needed.

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

“…While the body of literature finds sex work associated with elevated HIV risk , we did not find such a direct association in our study. We suspect a likely response bias of under‐reporting because sex work is illegal in China , as in much of the world.…”

“…As the case in many settings, data on transgender women are not distinguished in public health surveillance systems, or are merged with MSM, obscuring the burden of HIV and drivers of transmission specific to this population [1, 15,16]. The first reported prevalence of HIV infection in a population of Chinese transgender women, in 2014 by Cai et al, was 25.9%, significantly higher than their local MSM counterparts [17]. The sample comprised only sex workers in the city of Shenyang.…”

Information-Motivation-Behavioral Skills model of consistent condom use among transgender women in Shenyang, China

“…The number might even be underestimated because of low rates of HIV testing among this particular population in China [9]. For example, in a cross-sectional study among 220 TGW sex workers conducted in 2014, 16.8% of the participants self-reported as HIV positive and another 9.1% were detected to be HIV positive through free HIV testing [10].…”

Where The Trans Men and Enbies At?: Cissexism, Sexual Threat, and the Study of Sex Work

“…There is no paucity of research articles on transgender women who work in the sex industry, and researchers have conducted studies around the globe and in countries such as China (Cai et al, ; Wang et al, ), Colombia (Bianchi et al, ), the Dominican Republic (Budhwani et al, ), India (Chakrapani, Newman, & Noronha, ), Jamaica (Logie et al, ), Malaysia (Nemoto, de Guzman, The, Iwamoto, & Trocki, ), Mexico (Infante, Sosa‐Rubi, & Cuadra, ), Pakistan (Collumbien et al, ; Usman, Khan, Bashir, Amjad, & Amjad, ); Peru (Degtyar et al, ), Portugal (Oliveira, ), South Africa (Samudzi & Mannell, ), Thailand, (Nemoto, de Guzman, et al, ), Turkey (Engin, ) and the United States (Nemoto, Operario, Keatley, Han, & Soma, , 2011; Sausa, Keatley, & Operario, , Wilson et al, , Hoffman, ). In much of this research, researchers focused on condomless sex between trans women who exchange sex for money with cisgender men, and how this high‐risk behavior contributed to high rates of HIV among transgender women in regions as diverse as China, Jamaica, Peru, and the Dominican Republic (e.g., Budhwani et al, ; Cai et al, ; Degtyar et al, ; Logie et al, ; Wang et al, ). Chakrapani et al, (2018) used a social exclusion framework that, without using the language of cissexism, examined the role of gender discrimination and marginalization as a motivation for trans women to trade sex.…”