Weissman Amy, Ngak Song, Srean Chhim, Sansothy Neth, Mills Stephen, Ferradini Laurent
FHI 360, Phnom Penh, Cambodia.
National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, (NCHADS) and University of Health Science, Phnom Penh, Cambodia.
PLoS One. 2016 Apr 12;11(4):e0152906. doi: 10.1371/journal.pone.0152906. eCollection 2016.
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.
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.
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.
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.
鉴于认识到跨性别者感染艾滋病毒的风险很高，并且为了为政策制定和项目规划提供信息，我们在柬埔寨的跨性别者中开展了一项艾滋病毒流行率和风险行为调查。
采用应答驱动抽样方法进行横断面调查，并通过自我管理的音频计算机辅助访谈进行。在问卷调查之前进行艾滋病毒检测，检测结果在检测后立即可得。符合条件的参与者年龄≥18岁，出生时被认定为男性且自我认定/表达为不同性别，并且报告在过去一年中与至少一名男性伴侣发生过性行为。从柬埔寨的六个主要城市中心招募了891名跨性别者。
891名参与者中的大多数自我认定为第三性别或女性（94.5%），年龄较轻（中位年龄23岁，四分位间距[20 - 27]），接受过中等教育或更高教育（80.5%），未婚（89.7%），有工作（90.2%）。大多数人在18岁之前首次发生性行为（66.8%），与男性发生性行为（79.9%），其中37.9%的人首次性行为有报酬或支付了报酬。参与者中的艾滋病毒阳性率为4.15%。与男性和女性伴侣始终坚持使用避孕套的比例在所有伴侣类型中都很低，但在为性行为付费时与男性伴侣使用避孕套的比例尤其低（20.3%）。大多数参与者报告一生中曾遭受过歧视（54.8%），30.3%的人曾遭受过攻击。多变量分析显示，年龄较大（35 - 44岁调整后的比值比 = 14.73 [4.20, 51.67]，30 - 34岁调整后的比值比 = 7.63 [2.55, 22.81]）、仅接受过小学教育或未接受过任何教育（调整后的比值比 = 2.62 [1.18, 5.80]）、是暹粒居民（调整后的比值比 = 7.44 [2.37, 23.29]）、首次性行为有报酬（调整后的比值比 = 2.26 [1.00, 5.11]）、在使用毒品期间/之后发生性行为（调整后的比值比 = 2.90 [1.09, 7.73]）、在最后一次肛交时未坚持使用避孕套（调整后的比值比 = 3.84 [1.58, 9.33]）以及报告自尊心较低（调整后的比值比 = 3.25 [1.35, 7.85]）与艾滋病毒感染独立相关。
本研究证实跨性别者是柬埔寨艾滋病毒感染风险最高的群体之一。这表明需要制定项目策略来降低已确定的相关风险，并为该人群提供获得艾滋病毒护理的便利。
