尼泊尔跨性别女性的基于人群的艾滋病毒流行率、污名和艾滋病毒风险。
Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal.
机构信息
San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.
Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal.
出版信息
BMC Infect Dis. 2021 Jan 29;21(1):128. doi: 10.1186/s12879-021-05803-7.
BACKGROUND
Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions.
METHODS
In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma.
RESULTS
Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67-0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01-1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20-0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03-1.78; p = 0·03; aPR 1.45; 95% CI 1.03-2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work.
CONCLUSIONS
Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.
背景
尼泊尔跨性别女性（跨性别女性）在艾滋病毒应对措施中服务不足。需要数据来确定从其他重点人群中分离出来的艾滋病毒流行率，并确定该群体面临的特定风险。跨性别女性在世界各地都处于边缘化地位，还需要研究来确定耻辱感对艾滋病毒风险的影响，以便为具体的跨性别干预措施提供信息。
方法
2019 年，我们使用 respondent driven sampling（RDS）对其他重点人群中分离出来的跨性别女性进行了首次基于人群的艾滋病毒行为监测研究。我们估计了跨性别女性的艾滋病毒流行率，并构建了双变量和多变量泊松二项式回归模型，以研究艾滋病毒风险与耻辱感之间的关系。
结果
跨性别女性参与者（N=200）的平均年龄为 33 岁（标准差=10.96）。我们发现加权艾滋病毒流行率为 11.3%（95%CI 6·82% - 18·13）。我们发现抑郁和焦虑（aPR 0.81；95%CI 0.67-0.97；p=0·02）和当前从事性工作（aPR 1.31；95%CI 1.01-1.71；p=0·046）与无保护的接受性肛交的流行率显著相关。我们发现，由于性别认同而曾经遭受过言语虐待的经历性耻辱感与抑郁和焦虑的低流行率显著相关（aPR 0.42；95%CI 0.20-0.87；p=0·002）。在尼泊尔社会中不被接受，并且认为人们因为自己的跨性别身份而认为他们是罪犯，这与当前从事性工作的更高流行率显著相关（aPR 1.36；95%CI 1.03-1.78；p=0·03；aPR 1.45；95%CI 1.03-2.07；p=0·04）。评估的每一项经历性耻辱感指标都与当前从事性工作的更高流行率显著相关。
结论
尼泊尔的跨性别女性受到高度歧视，导致个人和系统因素影响他们感染艾滋病毒的风险。需要采取干预措施，支持跨性别女性的经济和心理健康，以防止因耻辱感而使她们面临更高的艾滋病毒风险。
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