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

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Amy Weissman ; Song Ngak ; Chhim Srean ; Neth Sansothy ; Stephen Mills ; Laurent Ferradini
  • Publisher: Public Library of Science (PLoS)
  • Journal: PLoS ONE, volume 11, issue 4 (issn: 1932-6203, eissn: 1932-6203)
  • Related identifiers: pmc: PMC4829243, doi: 10.1371/journal.pone.0152906
  • Subject: Microbial Pathogens | HIV epidemiology | Research Article | HIV infections | Sexual Preferences | Infectious diseases | Preventive medicine | Pathology and Laboratory Medicine | Geographical Locations | Cambodia | Alcohol Consumption | Commerce | Men WHO Have Sex with Men | Immunodeficiency Viruses | Retroviruses | Epidemiology | Population Groupings | HIV | Pathogens | People and Places | Public and occupational health | Payment | Diet | Lentivirus | Viruses | Biology and Life Sciences | HIV prevention | Asia | Microbiology | Medicine | Viral diseases | Medical Microbiology | Viral Pathogens | Q | Nutrition | Economics | R | RNA viruses | Social Sciences | Science | Organisms | Medicine and health sciences

INTRODUCTION:Recognizing 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. METHODS:Cross-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. RESULTS:The 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. CONCLUSIONS:This 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.
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