Abstract
BackgroundTransgender 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.MethodsIn 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.ResultsTrans 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.ConclusionsTrans 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.
Highlights
Transgender women in Nepal are underserved in the Human immunodeficiency virus (HIV) response
After adjusting for respondent driven sampling (RDS)-weights and covariates in the multivariable Poisson binomial regression model, we found that current engagement in sex work was significantly associated with greater prevalence of condomless receptive anal intercourse (Table 4)
Much like in other places around the world, we found that trans women are highly and disproportionately impacted by HIV
Summary
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 needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. Transgender women (trans women) are one of the most severely impacted and underserved key populations in the global response to HIV (human immunodeficiency virus). Studies in Nepal combine trans women with MSM, but no study has estimated the prevalence of HIV among trans women alone. Aggregated data limits what we know about the specific risks and vulnerabilities trans women in Nepal face that are different from MSM.
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