Similar Sexually Transmitted Infections Prevalence Despite Lower HIV Prevalence Among Transgender Women Compared with Men Who Have Sex With Men in Thai Community-Based Test and Treat Cohort

Abstract

Background Men who have sex with men (MSM) and transgender women (TG) are at increased risk for sexually transmitted infections (STIs). To understand potential different characteristics, we assessed gender-specific, demographic data, behavioral risks and prevalence of STIs.Methods Thai MSM and TG aged ≥18 years from six community-based organizations in Thailand were enrolled into the Test and Treat cohort during 2015–2016. Baseline demographic and behavior risk assessment and HIV/STIs testing were done. Blood for syphilis serology and pharyngeal and anal swab, and urine for gonorrhea and chlamydia nucleic acid amplification testing were collected. Logistic regression was used to determine factors associated with gender-specific STIs prevalence.ResultsFrom 1862 MSM and 787 TG enrolled, 874 (33%) had STI and 402 (15.2%) were HIV-positive. Compared with MSM, more TG were single (79.7% vs. 71.6%), had lower education (23.6% vs. 40% with diploma or higher), had lower income (35.7% vs. 42.6% gained >288 USD/month), had first sex at young age (20.1% vs. 12.8% at <15 years old), and reported >3 sexual partners in the past 6 months (32.9% vs. 24.6%) (all P < 0.001). The overall STIs prevalence was similar between both genders (31.5% vs. 33.6%, P = 0.29), but TG had lower HIV prevalence (8.9% vs. 17.8%, P < 0.001). TG had higher prevalence of pharyngeal and anal chlamydia (5.5% vs. 2.9%, P = 0.001 and 19.5% vs. 15.1%, P = 0.007, respectively), while syphilis prevalence was higher in MSM (9.9% vs. 3.6%, P < 0.001). Among HIV-positive participants, MSM had higher prevalence of HIV and syphilis coinfection (26.2% vs. 8.6%, P = 0.001). STIs prevalence among TG was associated with HIV-positive status (adjusted odd ratio [aOR] 2.74; 95% CI 1.52–4.95, P = 0.001), having multiple sexual partners or refused to answer (aOR 2.36; 95% CI 1.31–4.24, P = 0.004 and 2.33; 95% CI 1.24–4.37, P = 0.009, respectively) and unprotected sexual intercourse (aOR 1.66; 95% CI 1.02–2.69, P = 0.041).Conclusion Almost one-third of TG enrolled into the Test and Treat cohort had STI. TG had lower HIV prevalence but similar STIs prevalence compared with MSM, despite practicing riskier sexual behaviors. Our findings signified the importance of studying TG sexual networks in Thailand to better strategize sexual health programs.Disclosures All authors: No reported disclosures.