在尼日利亚阿布贾和拉各斯，与男性发生性行为的成年人中，性别认同与性行为、社会耻辱感和性传播感染之间的关联。

Associations of gender identity with sexual behaviours, social stigma and sexually transmitted infections among adults who have sex with men in Abuja and Lagos, Nigeria.

机构信息

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.

Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.

出版信息

J Int AIDS Soc. 2022 Jul;25(7):e25956. doi: 10.1002/jia2.25956.

INTRODUCTION

Sexual and gender minority populations are disproportionately affected by the global syndemic of HIV and other sexually transmitted infections (STIs). We hypothesized that transgender women (TGW) and non-binary individuals in Nigeria have more STIs than cis-gender men who have sex with men (cis-MSM), and that experiences of stigma and sexual practices differ between these three groups.

METHODS

From 2013 to 2020, TRUST/RV368 enrolled adults assigned male sex at birth who reported anal sex with men in Abuja and Lagos, Nigeria. Participants were tested for STIs and completed questionnaires about sexual behaviours and social stigma every 3 months. Participants were categorized as cis-MSM, TGW or non-binary/other based on self-reported gender identity. Gender group comparisons were made of HIV, gonorrhoea and chlamydia prevalence and incidence; stigma indicators; and condom use during anal sex.

RESULTS

Among 2795 participants, there were 2260 (80.8%) cis-MSM, 284 (10.2%) TGW and 251 (9.0%) non-binary/other individuals with median age of 23 years (interquartile range 20-27). HIV prevalence among cis-MSM, TGW and non-binary/other participants was 40.8%, 51.5% and 47.6%, respectively (p = 0.002). HIV incidence was 8.7 cases per 100 person-years (PY) (95% confidence interval [CI] 6.9-10.8), 13.1 cases/100 PY (95% CI 6.5-23.4) and 17.6 cases/100 PY (95% CI 9.8-29.0, p = 0.025), respectively. Anorectal gonorrhoea incidence was lower in cis-MSM than TGW (22.2 [95% CI 19.6-25.0] vs. 35.9 [95% CI 27.3-46.3]). TGW were more likely than cis-MSM to report being affected by stigma, including assault (47.2% vs. 32.3%), fear of walking around (32.4% vs. 19.2%) and healthcare avoidance (25.0% vs. 19.1%; all p < 0.05). TGW were more likely to report always using condoms than non-binary/other individuals (35.3% vs. 26.2%, p = 0.041) during receptive anal sex.

CONCLUSIONS

Sexual and gender minorities in Nigeria have heterogeneous sexual behaviours and experiences of social stigma that may influence the vulnerability to HIV and other STIs. There is a need for tailored interventions that acknowledge and are informed by gender. Further research is needed, particularly among understudied non-binary individuals, to better understand disparities and inform tailored interventions to improve outcomes among these communities.

介绍

性少数群体和性别少数群体受到艾滋病毒和其他性传播感染（STI）全球综合征的不成比例影响。我们假设尼日利亚的跨性别女性（TGW）和非二元个体比与男性发生性关系的顺性别男性（cis-MSM）有更多的性传播感染，并且这些群体之间存在不同的耻辱感和性行为。

方法

2013 年至 2020 年，TRUST/RV368 招募了出生时被指定为男性且在阿布贾和拉各斯报告与男性发生肛交的成年人。参与者接受了性传播感染检测，并每 3 个月完成一次关于性行为和社会耻辱感的调查问卷。参与者根据自我报告的性别认同被归类为 cis-MSM、TGW 或非二元/其他。比较了 HIV、淋病和衣原体的患病率和发病率；耻辱感指标；以及肛交时使用避孕套的情况。

结果

在 2795 名参与者中，有 2260 名（80.8%）cis-MSM、284 名（10.2%）TGW 和 251 名（9.0%）非二元/其他个体，中位年龄为 23 岁（四分位间距 20-27）。cis-MSM、TGW 和非二元/其他参与者的 HIV 患病率分别为 40.8%、51.5%和 47.6%（p = 0.002）。HIV 发病率分别为每 100 人年 8.7 例（95%置信区间 6.9-10.8）、每 100 人年 13.1 例（95%置信区间 6.5-23.4）和每 100 人年 17.6 例（95%置信区间 9.8-29.0，p = 0.025）。与 cis-MSM 相比，肛交淋病的发病率在 TGW 中较低（22.2 [95%置信区间 19.6-25.0] 与 35.9 [95%置信区间 27.3-46.3]）。与 cis-MSM 相比，TGW 更有可能受到耻辱感的影响，包括攻击（47.2% vs. 32.3%）、害怕四处走动（32.4% vs. 19.2%）和避免医疗保健（25.0% vs. 19.1%；所有 p < 0.05）。与非二元/其他个体相比，TGW 更有可能在接受性肛交时始终使用避孕套（35.3% 与 26.2%，p = 0.041）。