Factors associated with condom use with non-commercial partners among sexually-active transgender women in Cambodia: findings from a national survey using respondent-driven sampling

Siyan Yi,Navy Chann,Srean Chhim,Phalkun Mun,Sovannary Tuot,Pheak Chhoun,Amelia Plant,Carinne Brody

doi:10.1186/s12889-019-6656-x

Abstract

BackgroundGlobally, the prevalence of HIV among transgender women is much higher than that of the general adult population. This can be explained by the persistently low rate of consistent condom use among this population. This study was therefore conducted to explore factors associated with consistent condom use among sexually-active transgender women in Cambodia, specifically with their non-commercial partners.MethodsData used for this study were collected as part of the National Integrated Biological and Behavioral Survey 2016. Participants were recruited from the capital city of Phnom Penh and 12 other provinces with high burden of HIV using the Respondent-Driven Sampling (RDS) method. Face-to-face interviews were conducted using a structured questionnaire. Weighted multivariate logistic regression analysis was conducted to explore independent factors associated with consistent condom use.ResultsThis study included 1202 transgender women who reported having anal sex with at least one male partner not in exchange for money or gifts in the past three months. The mean age of the participants was 26.0 (SD = 7.0) years. Of the total, 41.5% reported always using condoms with male non-commercial partners in the past three months. After adjustment, the likelihood of consistent condom use was significantly higher among participants who resided in an urban community (AOR = 1.7, 95% CI = 1.1–2.6), had attained at least 10 years of formal education (AOR = 1.8, 95% CI = 1.2–2.7), perceived that they were likely or very likely to be HIV infected (AOR = 2.9, 95% CI = 2.0–4.1), reported drinking alcohol two to three times per week (AOR = 3.1, 95% CI = 1.1–8.3), reported using amphetamine-type stimulants (AOR = 1.9, 95% = 1.1–3.8) or other drugs (AOR = 7.6, 95% CI = 1.5–39.5), and reported inconsistent condom use with male commercial partners in the past three months (AOR = 4.3, 95% CI = 1.8–10.4) compared to that of their respective reference group.ConclusionsThis study confirms the low rates of condom use, particularly in non-commercial relationship, among transgender women in Cambodia. To address these concerns, efforts towards education about effects of multiple, concurrent relationships, and inconsistent condom use should be reinforced among transgender women.

Highlights

The prevalence of Human immunodeficiency virus (HIV) among transgender women is much higher than that of the general adult population
The likelihood of consistent condom use was significantly higher among participants who resided in urban communities (AOR = 1.7, 95% confidence interval (CI) = 1.1–2.6), had attained at least 10 years of formal education (AOR = 1.8, 95% CI = 1.2–2.7), perceived that they were likely or very likely to be HIV
This study confirms the persistently low rates of condom use, in non-commercial relationship among transgender women in Cambodia. It showed that lower perceived risk of HIV was associated with lower condom use rates, regardless of the actual risk

Summary

Introduction

The prevalence of HIV among transgender women is much higher than that of the general adult population. Transgender women, individuals who self-identify as female despite being assigned as male at birth, are a vulnerable population globally They experience a high degree of social marginalization that results in mental health challenges, substance abuse, and exposure to violence—all risk factors for HIV and other sexually transmitted infections (STIs) [1,2,3,4,5,6]. The double stigmatization of gender identity and prostitution makes this population even less likely to access health services [7, 9, 10] This lack of access has serious consequences, as the risk of HIV and other STIs is higher among transgender women who are engaging in transactional sex [10, 11]. Many transgender women experience financial isolation or destitution, and have had to make the difficult decision to engage in sex without a condom as an economic survival strategy [5, 10, 13]

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Results

Discussion

Conclusion