Abstract
Transgender women are particularly at risk of HIV infection, but little evidence exists on effective HIV prevention strategies with this population. We evaluated whether Sisters, a peer-led program for transgender women, could reduce HIV risks in Pattaya, Thailand. The study used time-location sampling to recruit 308 transgender women in Pattaya into a behavioral survey in 2011. Coarsened exact matching was used to create statistically equivalent groups of program participants and non-participants, based on factors influencing likelihood of program participation. Using multivariable logistic regression, we estimated effects of any program participation and participation by delivery channel on: condom use at last sex; consistent condom and condom/water-based lubricant use in the past 3 months with commercial, casual, and regular partners; and receipt of HIV testing in the past 6 months. Program coverage reached 75% of the population. In a matched sub-sample (n = 238), participation in outreach was associated with consistent condom/water-based lubricant use with commercial partners (AOR 3.22, 95% CI 1.64–6.31). Attendance at the Sisters drop-in center was associated with receiving an HIV test (AOR 2.58, 95% CI 1.47–4.52). Dedicated transgender-friendly programs are effective at reducing HIV risks and require expansion to better serve this key population and improve HIV prevention strategies.
Highlights
Thailand experiences a concentrated HIV epidemic with 1.2% of the general population, or 490,000, people estimated to be living with HIV [1]
While the Thai government has been credited with slowing the spread of HIV in the general population, key populations remain at significant risk for HIV infection [2,3]
We aimed to assess whether a targeted HIV prevention program for transgender women in Pattaya, Thailand could reduce HIV risks through promotion of condom and water-based lubricant use and HIV counseling and testing, and we find positive evidence to that effect
Summary
Thailand experiences a concentrated HIV epidemic with 1.2% of the general population, or 490,000, people estimated to be living with HIV [1]. While the Thai government has been credited with slowing the spread of HIV in the general population, key populations remain at significant risk for HIV infection [2,3]. Transgender women represent a distinct population often subsumed within men who have sex with men (MSM), but with unique social, cultural and behavioral characteristics that make them vulnerable to HIV infection [4]. A recent systematic review and meta-analysis found a high burden of HIV among transgender women globally and estimated HIV prevalence in Thailand at 12.5% [5]. Global epidemiological studies have placed HIV prevalence among transgender populations at anywhere from 8% to 68% [6,8,9,10]
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