Dear Nicole, Francisco Leilani, Pitisutthithum Punnee, Nitayaphan Sorachai, Schuetz Alexandra, Wansom Tanyaporn, O'Connell Robert J, Crowell Trevor A, Vasan Sandhya
US 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.
Transgend Health. 2023 Jul 28;8(4):371-380. doi: 10.1089/trgh.2021.0192. eCollection 2023 Aug.
Transgender women (TGW) and cisgender men who have sex with men (cis-MSM) are often grouped together as key populations. We evaluated behavioral and other characteristics that may distinguish TGW from cis-MSM in Bangkok, Thailand.
We enrolled into an 18-month cohort cis-MSM and TGW 18-35 years of age without HIV, who reported anal intercourse plus condomless anal intercourse, multiple partners, transactional sex, and/or sexually transmitted infection. Robust multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and confidence intervals (95% CIs) for associations with being a TGW. Among TGW, logistic regression with generalized estimating equations was used to estimate adjusted odds ratios (aORs) and 95% CIs for associations with taking hormones and having undergone gender affirmation surgery (GAS).
From 2017 to 2019, 660 cis-MSM and 348 TGW were enrolled. Compared to cis-MSM, TGW were more likely to be attracted to mostly/only men (aPR: 3.79, 95% CI: 1.57-9.13), have a higher monthly income (aPR: 1.25, 95% CI: 1.04-1.50), have lived in their current residence for <1 year (aPR: 1.21, 95% CI: 1.01-1.46), have engaged in sex work (aPR: 1.48, 95% CI: 1.23-1.77), and be less likely to have ever undergone HIV testing (aPR: 0.83, 95% CI: 0.70-0.98). Among TGW, 149 (42.8%) were taking hormones and 33 (9.5%) had undergone GAS. GAS was more common among TGW who ever used methamphetamines (aOR: 1.55, 95% CI: 1.00-2.41) and those >23 years (18-20-year olds aOR: 0.17, 95% CI: 0.05-0.55; 21-23-year olds aOR: 0.36, 95% CI: 0.20-0.65).
TGW and cis-MSM are unique populations; tailored, gender-affirming, differentiated models of HIV prevention and care are necessary to address vulnerabilities specific to each key population.
跨性别女性（TGW）和与男性发生性关系的顺性别男性（cis-MSM）常被归为关键人群。我们评估了泰国曼谷可能区分TGW和顺性别男男性行为者的行为及其他特征。
我们招募了年龄在18至35岁、无艾滋病毒的顺性别男男性行为者和跨性别女性进入一个为期18个月的队列研究，这些人报告有肛交、无保护肛交、多个性伴侣、交易性行为和/或性传播感染。使用稳健的多变量泊松回归来估计与成为跨性别女性相关的调整患病率比（aPRs）和置信区间（95%CI）。在跨性别女性中，使用广义估计方程的逻辑回归来估计与服用激素和接受性别确认手术（GAS）相关的调整优势比（aORs）和95%CI。
2017年至2019年，招募了660名顺性别男男性行为者和348名跨性别女性。与顺性别男男性行为者相比，跨性别女性更有可能主要/只被男性吸引（aPR：3.79，95%CI：1.57 - 9.13），月收入更高（aPR：1.25，95%CI：1.04 - 1.50），在当前住所居住时间<1年（aPR：1.21，95%CI：1.01 - 1.46），从事性工作（aPR：1.48，95%CI：1.23 - 1.77），且接受过艾滋病毒检测的可能性较小（aPR：0.83，95%CI：0.70 - 0.98）。在跨性别女性中，149人（42.8%）正在服用激素，33人（9.5%）接受过性别确认手术。性别确认手术在曾使用甲基苯丙胺的跨性别女性中更常见（aOR：1.55，95%CI：1.00 - 2.41），在年龄>23岁的人群中更常见（18 - 20岁人群aOR：0.17，95%CI：0.05 - 0.55；21 - 23岁人群aOR：0.36，95%CI：0.20 - 0.65）。
跨性别女性和顺性别男男性行为者是独特的人群；需要针对性别确认的、有差异的艾滋病毒预防和护理模式来应对每个关键人群特有的脆弱性。
