Abstract
IntroductionGrowing evidence suggests increased HIV incidence in the Middle East and North Africa among “key populations.” To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region. Through the lens of the Gender Affirmation Framework, we assessed demographic correlates of risk behaviour and the prevalence of HIV among trans feminine individuals in Lebanon.MethodsLong-chain referral sampling was used to recruit 53 participants for completion of a behavioural survey and optional free rapid HIV tests. Data were collected using interviewer-administered questionnaires. A multivariable logistic regression model was used to identify demographic determinants of HIV risk behaviour.ResultsFifty-seven percent of participants reported condomless receptive anal intercourse (CRAI) with male partner(s) in the last three months, 40% of whom reported not knowing the HIV status of the partner(s). Of the participants tested for HIV as part of the study or via self-report, four (10%) were HIV positive; 13 declined HIV testing. Forty percent of the sample had no prior history of HIV testing. A history of trauma such as sexual abuse/assault was reported by almost half of the participants (49%). Sixty-eight percent reported experiencing physical violence and 32% police arrest, because of gender identity or presentation. A staggering 98% reported having experienced gender identity or gender presentation-related discrimination. Sixty-six percent of the sample reported current sex work; sex work was correlated with CRAI but was not significant in multivariate analysis. In regression analysis, “openness”/“outness” about transgender identity at work or school was significantly associated with CRAI. Surprisingly, a history of sexual abuse/assault was negatively correlated with CRAI, suggesting the need for further inquiry.ConclusionsThe results of this study provide implications for how to address sexual health among trans feminine individuals in Lebanon and the greater Middle East and North Africa region.
Highlights
Growing evidence suggests increased HIV incidence in the Middle East and North Africa among ‘‘key populations.’’ To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region
Within the Middle East and North Africa (MENA) region, the likelihood of the development of concentrated epidemics has been identified in Egypt, Yemen, Oman and Lebanon among ‘‘key populations’’ including men who have sex with men (MSM) and transgender populations [2]
Most HIV research to date that has taken place in MENA has failed to distinguish between MSM and transgender women [2]; little is known about HIV risk behaviour in this population despite staggeringly high rates of risk and infection globally
Summary
Growing evidence suggests increased HIV incidence in the Middle East and North Africa among ‘‘key populations.’’ To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region. Through the lens of the Gender Affirmation Framework, we assessed demographic correlates of risk behaviour and the prevalence of HIV among trans feminine individuals in Lebanon. Transgender women’s risk of HIV infection has been identified as 49 times higher than members of the general population throughout the globe [3], epidemiological data have yet to include and measure HIV prevalence and risk among trans feminine individuals in MENA [2]. Transgender women have reported high rates of having never been tested for HIV, ranging, for example, from 42% in Ontario, Canada [12], to 50% in Bangkok, Thailand [13]
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