Transgender women are a vulnerable and key risk group for
HIV, and most research has shown an increased frequency of HIV infection among
this minority population. This study examined the prevalence of HIV-related
sexual risk behaviors and the socio-demographic correlates with HIV-related
sexual risk behaviors among male-to-female (MtF) transgender persons.
Data were collected from a sample of 232 individuals through
venue-based and snowball sampling and face-to-face interviews.
The HIV-related sexual risk behaviors among the MtF
transgender persons were: sex without using a condom (48.3%), unprotected anal sex (68.1%), and
unprotected sex with multiple partners (88.4%). Statistically
significant differences were found for age, income, education, alcohol habit,
and sex with more than two partners per day for these three different
HIV-related sexual risk behaviors. MtF transgender persons with a secondary or
higher level of education were three times (OR 2.93) more likely to have
unprotected sex with multiple partners compared to those with a primary level
or no education.
Age, education, income, frequency of daily sexual contact,
and an alcohol habit remain significant with regard to HIV-related sexual risk
behavior. There is an urgent need for programs and interventions to reduce
risky sexual behaviors in this minority population.
| Characteristics | Prevalence % (95% CI) |
|---|---|
| Alcohol in last 6 months | 68.5 (62.6–74.4) |
| Smoking in last 6 months | 58.2 (51.9–64.5) |
| Sex without using a condom in last 6 months | 48.3 (41.8–54.8) |
| Unprotected sex with multiple partners in last 6 months | 88.4 (84.3–92.5) |
| Unprotected anal sex in last 6 months | 68.1 (62.0–74.2) |
| Unprotected oral sex in last 6 months | 51.5 (45.0–58.0) |
| Other sex in last 6 months | 6.1 (3.0–9.2) |
...Unemployment and poverty were common among the transgender
persons, as in other populations in Nepal. Nearly half of the respondents had
no formal employment and a fourth of the participants indicated that they had a
low income status, which is less than two dollars per day. The study also found
that nearly a third of participants had sexual intercourse with more than one
sex partner per day, which indicates a great risk for HIV and sexually
transmitted diseases. A previous study has highlighted that the MtF population
engages with a higher number of sexual associates.13
The findings regarding substance use suggest that alcohol
consumption is widespread in the transgender population. This may be considered
a serious public health problem, given that more than two-thirds of the
participants had an alcohol drinking habit. Similarly, nearly three-fifths of
the participants had a smoking habit. Unprotected sex with multiple partners
was found to differ significantly by alcohol and smoking habits. Previous
studies have found alcohol to be associated with HIV risk among sex workers and
those having unprotected sexual intercourse.3, 27, 28, 29 However,
there is no previous evidence for the association between HIV-related sexual
risk behavior and smoking. Nearly half of the participants engaged in unsafe
sex and did not use a condom with their sex partners. Previous studies have
revealed irregular and low-level condom use among MtF populations.13, 18, 19, 20, 21 However,
the great majority of the participants had multiple sex partners. Anal sex
appears to be the most common sexual behavior among the MtF transgender
persons.
The results showed no distinctive variations in HIV risk
behavior among the age groups. Sex without using a condom and unprotected anal
sex were found to differ significantly by age group. However, HIV risk behavior
was found to be more common among the more educated participants. Educated
respondents were three times more likely to have unprotected sex with multiple
partners than the less educated and this was statistically significant.
Previous studies have found the level of education to be positively correlated
with unprotected sex.1 Having very limited
comparable data, the researcher proposes an explanation. Transgender persons
with a higher education level may find it easier to build a network with varied
sexual associates than less educated persons and may thus be further expected
to engage in more unprotected sexual acts. They might be unaware that they are
themselves at risk either because of the self-confidence that education may
bring or because they are unaware or do not care to see their sexual partners
as being at risk of HIV. Unprotected sex with multiple partners was found to be
significantly associated with income. Risky sexual intercourse might be
encouraged with the influence of money and somewhat higher in the highest
income group than in the lowest income group.
Full article
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- 1Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal. Electronic address: dnbhatta@yahoo.com.
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