1
|
Wirtz AL, Restar A. Gender-affirming HIV care as a tool to end the HIV epidemic. Lancet HIV 2023:S2352-3018(23)00087-5. [PMID: 37119826 DOI: 10.1016/s2352-3018(23)00087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Arjee Restar
- Departments of Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, WA, USA; Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
2
|
Wirtz AL, Logie CH, Mbuagbaw L. Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research. Epidemiol Rev 2022; 44:87-109. [PMID: 36124659 PMCID: PMC10362940 DOI: 10.1093/epirev/mxac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022] Open
Abstract
Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.
Collapse
Affiliation(s)
- Andrea L Wirtz
- Correspondence to Dr. Andrea L. Wirtz, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 (e-mail: )
| | | | | |
Collapse
|
3
|
Dear N, Francisco L, Pitisutthithum P, Nitayaphan S, Schuetz A, Wansom T, O'Connell RJ, Crowell TA, Vasan S. Unique HIV Risk Factors and Prevention Needs for Transgender Women and Cisgender Men Who Have Sex with Men in Bangkok, Thailand. Transgend Health 2022. [PMID: 37529407 PMCID: PMC10389251 DOI: 10.1089/trgh.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Transgender women (TGW) and cisgender men who have sex with men (cis-MSM) are often grouped together as key populations. We evaluated behavioral and other characteristics that may distinguish TGW from cis-MSM in Bangkok, Thailand. Methods We enrolled into an 18-month cohort cis-MSM and TGW 18-35 years of age without HIV, who reported anal intercourse plus condomless anal intercourse, multiple partners, transactional sex, and/or sexually transmitted infection. Robust multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and confidence intervals (95% CIs) for associations with being a TGW. Among TGW, logistic regression with generalized estimating equations was used to estimate adjusted odds ratios (aORs) and 95% CIs for associations with taking hormones and having undergone gender affirmation surgery (GAS). Results From 2017 to 2019, 660 cis-MSM and 348 TGW were enrolled. Compared to cis-MSM, TGW were more likely to be attracted to mostly/only men (aPR: 3.79, 95% CI: 1.57-9.13), have a higher monthly income (aPR: 1.25, 95% CI: 1.04-1.50), have lived in their current residence for <1 year (aPR: 1.21, 95% CI: 1.01-1.46), have engaged in sex work (aPR: 1.48, 95% CI: 1.23-1.77), and be less likely to have ever undergone HIV testing (aPR: 0.83, 95% CI: 0.70-0.98). Among TGW, 149 (42.8%) were taking hormones and 33 (9.5%) had undergone GAS. GAS was more common among TGW who ever used methamphetamines (aOR: 1.55, 95% CI: 1.00-2.41) and those >23 years (18-20-year olds aOR: 0.17, 95% CI: 0.05-0.55; 21-23-year olds aOR: 0.36, 95% CI: 0.20-0.65). Conclusions TGW and cis-MSM are unique populations; tailored, gender-affirming, differentiated models of HIV prevention and care are necessary to address vulnerabilities specific to each key population.
Collapse
Affiliation(s)
- Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Leilani Francisco
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Punnee Pitisutthithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sorachai Nitayaphan
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Alexandra Schuetz
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Tanyaporn Wansom
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Robert J. O'Connell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Sandhya Vasan
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | |
Collapse
|
4
|
Ye X, Li FR, Pan Q, Li Z, Yu GQ, Liu H, Liu J, Huai PC, Zhang FR. Prevalence and associated factors of sexually transmitted infections among methamphetamine users in Eastern China: a cross-sectional study. BMC Infect Dis 2022; 22:7. [PMID: 34983422 PMCID: PMC8725376 DOI: 10.1186/s12879-021-06987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of sexually transmitted infections (STIs) in China has been increasing over the last decades, especially among drug users, which has become one of the main burdens of public health in China. This study was conducted to estimate the prevalence and associated factors of STIs among non-injecting methamphetamine (MA) users in Eastern China. METHODS A cross-sectional survey was conducted among 632 MA users in Eastern China in 2017. Demographic characteristics, sexual behaviors, behaviors of MA use and sexual health knowledge were collected through questionnaire. First pass urine specimens were collected and detected for deoxyribonucleic acid (DNA) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with Nucleic Acid Amplification Technology (NAAT), while blood specimens were collected and detected for antibodies of Human immunodeficiency virus (HIV), Herpes simplex virus type-2 (HSV-2), and syphilis with enzyme-linked immune sorbent assay (ELISA). RESULTS Among the 632 MA users, 464 (73.42%) were males, 60.92% were < 35 years of age, 546 (86.39%) were Shandong residents. 317 (50.16%, 95% CI 46.26-54.06%) participants were tested positive for at least one kind of STIs, including 242 (38.29%, 95% CI 34.50-42.08%) for HSV-2, 107 (16.93%, 95% CI 14.01-19.85%) for active syphilis, 46 (7.28%, 95% CI 5.25-9.31%) for treated syphilis, 40 (6.33%, 95% CI 4.43-8.23%) for CT, 6 (0.95%, 95% CI 0.19-1.71%) for HIV, and 3 (0.47%, 95% CI 0.06-1.00%) for NG infection. 99 (15.66%, 95% CI 12.83-18.49%) participants were co-infected with two kinds of STIs, including 91 (14.40%, 95% CI 11.66-17.14%) participants were co-infected with HSV-2 and syphilis. 14 (2.22%, 95% CI 1.07-3.37%) participants were co-infected with three kinds of STIs, and 4 HIV positive participants were co-infected with both syphilis and HSV-2. In the multiple logistic regression analysis, the results showed that females (adjusted OR [AOR] = 7.30, 95% CI 4.34-12.30) and individuals ≥ 35 years of age (AOR = 2.97, 95% CI 2.04-4.32) were more likely to test positive for STIs among MA users, whereas participants who acquired sexual health knowledge primarily from the Internet (AOR = 0.57, 95% CI 0.40-0.82) and those whose regular partners did not use drugs (AOR = 0.59, 95% CI 0.37-0.94) were less likely. CONCLUSIONS This study found that the prevalence of HSV-2 and syphilis are alarming high among non-injecting MA users in Shandong Province in Eastern China. The prevention and control intervention of STIs among MA users in Shandong were needed, especially on females and MA users ≥ 35 years of age.
Collapse
Affiliation(s)
- Xing Ye
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Fu-Rong Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Zhen Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Gong-Qi Yu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Jian Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Peng-Cheng Huai
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China.
| | - Fu-Ren Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| |
Collapse
|
5
|
Stutterheim SE, van Dijk M, Wang H, Jonas KJ. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One 2021; 16:e0260063. [PMID: 34851961 PMCID: PMC8635361 DOI: 10.1371/journal.pone.0260063] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.
Collapse
Affiliation(s)
- Sarah E. Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mart van Dijk
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Asseervatham RA, Eng S, Eang S, Tuot S, Yi S. Barriers and facilitators of post-violence help-seeking behavior among 21-49-year-old transgender women in Phnom Penh: A qualitative study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:368-380. [PMID: 37901056 PMCID: PMC10601521 DOI: 10.1080/26895269.2021.1985677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: Transgender women are disproportionately affected by gender-based violence (GBV). However, little is known about how they respond to GBV. Aims: This study aims to understand transgender women's response to GBV and identify barriers and facilitators in accessing healthcare and legal aid after experiencing the violence. Methods: We conducted a qualitative study between February to March 2020 in Phnom Penh, Cambodia. Data were collected through in-depth interviews with 20 transgender women aged between 21 and 49 who had experienced GBV or knew a peer who had experienced GBV. Thematic analysis was conducted for the coding process, and an inductive approach was used to develop a coding frame. Results: All participants had experienced at least one form of GBV in their lifetime, and most participants had experienced multiple forms of GBV. However, most of them did not seek any services from healthcare providers, law enforcement officers, or assistance for healthcare and legal aid from non-governmental organizations (NGOs). Participants reported the following barriers to access to GBV services: anticipated stigma, the internalized stigma, which resulted in shame and low self-esteem, a lack of knowledge on NGOs' services that can assist with healthcare and legal aid, the perception that mental health services were unavailable, a lack of social support, enacted stigma by the police, and the perceived healthcare cost. The participants reported social support and knowledge of NGOs' services as facilitators of access to GBV service. Social media and NGO staff were reported to be preferred sources of information. Participants wanted more effective law enforcement services, comprehensive healthcare catered to the unique transgender women's needs, and non-discriminating service providers. Discussion: Interventions to address GBV and improve the health outcomes of transgender women should involve creating an enabling environment for help-seeking with the partnership between NGOs and different sectors and building social support.
Collapse
Affiliation(s)
- Rysheila Anne Asseervatham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Songheang Eang
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Social Sciences and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, California, USA
| |
Collapse
|
7
|
de Lind van Wijngaarden JW, van Griensven F, Sun LP, Wignall S. A scoping review of HIV epidemiologic, sociocultural and programmatic studies related to transgender women and men who have sex with men in Cambodia, 1999-2019. PLoS One 2021; 16:e0254490. [PMID: 34270600 PMCID: PMC8284612 DOI: 10.1371/journal.pone.0254490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research. Methods For this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations. Results Twenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia. Conclusions Research about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.
Collapse
Affiliation(s)
| | - Frits van Griensven
- Institute of Health Research and Innovation, Bangkok, Thailand
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Ly Penh Sun
- National Centre for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | | |
Collapse
|
8
|
Ayer A, Segura ER, Perez-Brumer A, Chavez-Gomez S, Fernandez R, Gutierrez J, Suárez K, Lake JE, Clark JL, Cabello R. Sexual health norms and communication patterns within the close social networks of men who have sex with men and transgender women in Lima, Peru: a 2017 cross-sectional study. BMC Public Health 2021; 21:1090. [PMID: 34098916 PMCID: PMC8186208 DOI: 10.1186/s12889-021-11091-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members' opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). METHODS In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. RESULTS Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM "never" discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them "at least once weekly" with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% "never") and most with transgender network members (27.1% "at least once weekly"). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. CONCLUSIONS Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. TRIAL REGISTRATION The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020 ) on January 4, 2017.
Collapse
Affiliation(s)
- Amrita Ayer
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. .,University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Amaya Perez-Brumer
- University of Toronto Dalla Lana School of Public Health, Toronto, Canada
| | | | | | | | | | - Jordan E Lake
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Asociación Civil Via Libre, Lima, Peru
| |
Collapse
|
9
|
Use of propensity score matching to create counterfactual group to assess potential HIV prevention interventions. Sci Rep 2021; 11:7017. [PMID: 33782485 PMCID: PMC8007631 DOI: 10.1038/s41598-021-86539-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/17/2021] [Indexed: 11/08/2022] Open
Abstract
The design of HIV prevention trials in the context of effective HIV preventive methods is a challenge. Alternate designs, including using non-randomised 'observational control arms' have been proposed. We used HIV simulated vaccine efficacy trials (SiVETs) to show pitfalls that may arise from using such observational controls and suggest how to conduct the analysis in the face of the pitfalls. Two SiVETs were nested within previously established observational cohorts of fisherfolk (FF) and female sex workers (FSW) in Uganda. SiVET participants received a licensed Hepatitis B vaccine in a schedule (0, 1 and 6 months) similar to that for a possible HIV vaccine efficacy trial. All participants received HIV counselling and testing every quarter for one year to assess HIV incidence rate ratio (IRR) between SiVET and non-SiVET (observational data). Propensity scores, conditional on baseline characteristics were calculated for SiVET participation and matched between SiVET and non-SiVET in the period before and during the SiVET study. We compared IRR before and after propensity score matching (PSM). In total, 3989 participants were enrolled into observational cohorts prior to SiVET, (1575 FF prior to Jul 2012 and 2414 FSW prior to Aug 2014). SiVET enrolled 572 participants (Jul 2012 to Apr 2014 in FF and Aug 2014 to Apr 2017 in FSW), with 953 non-SiVET participants observed in the SiVET concurrent period and 2928 from the pre-SiVET period (before Jul 2012 in FF or before Apr 2014 in FSW). Imbalances in baseline characteristics were observed between SiVET and non-SiVET participants in both periods before PSM. Similarly, HIV incidence was lower in SiVET than non-SiVET; SiVET-concurrent period, IRR = 0.59, 95% CI 0.31-0.68, p = 0.033 and pre-SiVET period, IRR = 0.77, 95% CI 0.43-1.29, p = 0.161. After PSM, participants baseline characteristics were comparable and there were minimal differences in HIV incidence between SiVET and non-SiVET participants. The process of screening for eligibility for efficacy trial selects participants with baseline characteristics different from the source population, confounding any observed differences in HIV incidence. Propensity score matching can be a useful tool to adjust the imbalance in the measured participants' baseline characteristics creating a counterfactual group to estimate the effect of interventions on HIV incidence.
Collapse
|
10
|
van Griensven F, de Lind van Wijngaarden JW, Eustaquio PC, Wignall S, Azwa I, Veronese V, Ferradini L, Phanuphak N, Mills S. The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming. Sex Health 2021; 18:21-30. [PMID: 33632379 DOI: 10.1071/sh20134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.
Collapse
Affiliation(s)
- Frits van Griensven
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok 10330, Thailand; and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand; and Department of Epidemiology and Biostatistics, University of California at San Francisco, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA; and Corresponding author.
| | | | | | - Stephen Wignall
- FHI 360 Cambodia, Phnom Penh Center, Building F, Samdach Sothearos Boulevard (3), Phnom Penh HW3M+9H, Cambodia
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Vanessa Veronese
- Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Laurent Ferradini
- FHI 360 Asia-Pacific Regional Office, 9 Witthayu Road, Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok 10330, Thailand; and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Stephen Mills
- FHI 360 Asia-Pacific Regional Office, 9 Witthayu Road, Bangkok 10330, Thailand
| |
Collapse
|
11
|
Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
Collapse
Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| |
Collapse
|
12
|
HIV Prevalence and Factors Related to HIV Infection Among Transgender Women in Vietnam: A Respondent Driven Sampling Approach. AIDS Behav 2020; 24:3132-3141. [PMID: 32297068 PMCID: PMC7223453 DOI: 10.1007/s10461-020-02867-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Transgender women are at higher risk of HIV infection, however, there is a lack of information about HIV infection and related factors among transgender women in Vietnam. From February 2018 to June 2018, 456 transgender women were recruited in the study using Respondent-Driven Sampling technique. Participants completed the computer-based questionnaire and were tested for HIV serostatus. Multivariable logistic regression was used to identify factors related to HIV infection. The prevalence of HIV infection was 77 (16.5%), of which 19 (24.7%) were not aware of their HIV-positive status prior to the study. Factors associated with HIV infection included popper use (aOR 2.01, p = 0.044) and having regular male partner(s) (aOR 0.42, p = 0.006). More efforts are needed to reduce the high prevalence of HIV infection, such as expanding the reach of HIV screening and prevention programs to the transgender women population, particularly for substance users.
Collapse
|
13
|
Sok S, Hong R, Chhoun P, Chann N, Tuot S, Mun P, Brody C, Yi S. HIV risks and recent HIV testing among transgender women in Cambodia: Findings from a national survey. PLoS One 2020; 15:e0238314. [PMID: 32886693 PMCID: PMC7473569 DOI: 10.1371/journal.pone.0238314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Globally, the prevalence of HIV among transgender women remains much higher than that of the general population, and a large proportion of them are unaware of their HIV status. Transgender women are exposed to gender-based violence and social stigma and discrimination in different settings that may create significant barriers to receiving HIV prevention and care services. This study aimed to identify factors associated with recent HIV testing among transgender women in Cambodia. Methods We conducted a cross-sectional survey in 2016 among 1375 transgender women recruited from 13 provinces using a peer-based social network recruitment method. We used a structured questionnaire for face-to-face interviews and performed rapid HIV/syphilis testing onsite. We used a multiple logistic regression analysis to identify factors associated with recent HIV testing. Results Of the total, 49.2% of the participants reported having an HIV test in the past six months. After controlling for other covariates, the odds of having an HIV test in the past six months was significantly lower among students (AOR 0.36, 95% CI 0.20–0.65), participants who perceived that they were unlikely to be HIV infected (AOR 0.50, 95% CI 0.32–0.78), and participants who reported always using condoms with male non-commercial partners in the past three months (AOR 0.65, 95% CI 0.49–0.85) relative to their respective reference group. The odds of having an HIV test in the past six months was significantly higher among participants who had been reached by community-based HIV services (AOR 5.01, 95% CI 3.29–7.65) and received HIV education (AOR 1.65, 95% CI 1.06–2.58) in the past six months relative to their respective reference group. Conclusions Despite the widely available free HIV testing services, more than half of transgender women in this study had not received an HIV test in the past six months. Our findings suggest that a tailored and comprehensive combination prevention program, in which HIV testing is linked to care continuum and beyond, maybe an essential next step. Social media may have the potential to be promoted and utilized among transgender women populations in order to improve HIV testing and other prevention measures.
Collapse
Affiliation(s)
- Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Carinne Brody
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, United States of America
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- * E-mail:
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Transgender (trans) populations are heavily impacted by HIV, yet face structural, social, and individual barriers to engagement in HIV prevention and care. In this review, we summarize the data on barriers and facilitators and discuss evidence-informed strategies to facilitate access to and engagement in HIV prevention and care by trans communities. RECENT FINDINGS Intersectional stigma and discrimination at structural, community, individual levels present substantial impediments to HIV prevention and optimal care. Access to gender-affirming health care is a priority for trans communities. Where trans communities are highly networked, these networks may provide a strong infrastructure for disseminating HIV innovations and reaching individuals who are not engaged in HIV services. Efforts to engage trans people in HIV prevention and care must address stigma, provide gender-affirming services, and build on community strengths and priorities to ensure trans populations achieve maximum benefit from advances in HIV prevention and care. SUMMARY Combination approaches that respond to the complex drivers of HIV in trans communities represent promising strategies for engaging trans people and their partners in HIV prevention and care.
Collapse
|
15
|
Yi S, Prem K, Chhoun P, Chann N, Tuot S, Mun P, Mburu G. Syphilis infection among people who use and inject drugs in Cambodia: a cross-sectional study using the respondent-driven sampling method. Int J STD AIDS 2020; 31:832-840. [PMID: 32623980 DOI: 10.1177/0956462420929132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cross-sectional study explored the prevalence and correlates of syphilis infection among people who use and inject drugs (PWUD/PWID) in Cambodia. Data were collected in 2017 from 1,677 PWUD/PWID living in the capital city of Phnom Penh and 11 other major provinces using the respondent-driven sampling method. The SD Bioline HIV/Syphilis Duo test was used to determine human immunodeficiency virus (HIV) and current or past syphilis infection. A multivariable logistic regression analysis was conducted to identify risk factors associated with current or past syphilis infection. The prevalence of current or past syphilis infection was 3.8% (95% confidence interval = 2.4-4.6). After adjustment, current or past syphilis infection remained positively associated with being female, living on the streets, having an average monthly income of US$100-299, having transactional sex in the past three months, and having been to a rehabilitation centre in the past 12 months. Current or past syphilis infection was negatively associated with having attained at least high school level of formal education. The findings indicate vulnerability to syphilis infection among PWUD/PWID in Cambodia, particularly among subpopulations who are more marginalized. Syphilis prevention and control programmes should be systematically integrated into HIV and sexually transmitted infection policy and services in the country.
Collapse
Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London, School of Hygiene & Tropical Medicine, London, UK
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Gitau Mburu
- Centre for Global Health Policy, University of Sussex, Brighton, UK
| |
Collapse
|
16
|
Yi S, Chann N, Chhoun P, Tuot S, Mun P, Brody C. Social marginalization, gender-based violence, and binge drinking among transgender women in Cambodia. Drug Alcohol Depend 2020; 207:107802. [PMID: 31846846 DOI: 10.1016/j.drugalcdep.2019.107802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transgender women experience disproportionate social stigma that may lead to behavioral risks and poor psychological wellbeing. This study examines social and behavioral factors associated with binge drinking among transgender women in Cambodia. METHODS A cross-sectional survey was conducted in 2016 among 1039 transgender women recruited from 13 provinces using the Respondent Driven Sampling method. A structured questionnaire was used for face-to-face interviews. Weighted multivariable logistic regression analysis was conducted to identify risk factors associated with binge drinking. RESULTS The prevalence of binge drinking was 43.3 %. After adjustment, the odds of binge drinking were significantly higher among participants in the age group of 25-34 compared to those in the age group of 18-24 and lower among participants in job categories such as hairdresser or beautician, office workers, and self-employed compared to those who were unemployed. The odds of binge drinking were significantly higher in participants who dropped out of school and thought it was because of their transgender identity, had transactional sex in the past three months, used amphetamine-type stimulants in the past three months, and reported experience of verbal abuse by family members during childhood. Regarding mental health, the odds of binge drinking were significantly lower among participants who had depressive symptoms over the past week. CONCLUSIONS These findings highlight the intersections between social marginalization, gender-based violence, HIV risks, and alcohol abuse. We recommend further exploration of the structural factors that may be modifiable through workplace policies or occupational health interventions among transgender women.
Collapse
Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; KHANA Center for Population Health Research, Phnom Penh, Cambodia; Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.
| | - Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, USA.
| |
Collapse
|
17
|
Mburu G, Tuot S, Mun P, Chhoun P, Chann N, Yi S. Prevalence and correlates of amphetamine-type stimulant use among transgender women in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:136-143. [DOI: 10.1016/j.drugpo.2019.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/06/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
|
18
|
Yan H, Xiao W, Chen Y, Chen Y, Lin J, Yan Z, Wilson E, McFarland W. High HIV prevalence and associated risk factors among transgender women in China: a cross-sectional survey. J Int AIDS Soc 2019; 22:e25417. [PMID: 31729178 PMCID: PMC6856602 DOI: 10.1002/jia2.25417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Transgender women may face the highest prevalence of HIV of any population, experiencing a disproportionate burden of disease frequently confirmed in surveys throughout the developing and developed world. However, few studies have been conducted specifically for transgender women in China. This study aimed to measure HIV prevalence and explore risk factors for infection in a diverse sample of Chinese transgender women to help advocate for prevention and care interventions for this population. METHODS From July 2018 to May 2019, we adapted a respondent-driven sampling (RDS) approach to recruit a diverse sample of 250 transgender women through chains of peer referrals in two cities of eastern China, Nanjing and Suzhou. Eligible participants (i.e. 18 years of age or older, living in Jiangsu province and assigned male sex at birth but currently self-identified as a gender different from male) completed a self-administered questionnaire on a mobile phone to collect demographic characteristics and risk behaviours and underwent HIV testing. RESULTS AND DISCUSSION The survey sample was young (82% under age 35 years), with 28.8% having a university degree, 39.2% reporting work at entertainment venues, 47.6% ever having taken hormones and 6.4% being diagnosed with an STI in the last year. One in five (20.8%) reported having engaged in sex work. HIV prevalence was 14.8% (95% CI 10.6 to 19.8), with 75.6% of those testing HIV positive reporting they were already aware of their serostatus. In multivariate analysis, HIV prevalence was significantly higher among transgender women above the age of 24 years, those who work at entertainment venues, who never have taken hormones, and who had been diagnosed with an STI in the last year. CONCLUSIONS The prevalence of HIV among transgender women in our study, at 14.8%, is among the highest detected in any population in eastern China. Chinese transgender women may therefore follow the disparity in the burden of HIV noted worldwide. Data support policies to prioritize transgender women for HIV testing outreach, for in-depth research to better understand the specific drivers of infection in this population, and for trans-friendly HIV care and prevention programmes to address their specific needs.
Collapse
Affiliation(s)
- Hongjing Yan
- Section of AIDS Control and PreventionJiangsu Provincial Center for Disease Control and PreventionNanjingChina
| | | | - Yunting Chen
- Section of AIDS Control and PreventionJiangsu Provincial Center for Disease Control and PreventionNanjingChina
| | - Yuanfang Chen
- Section of AIDS Control and PreventionJiangsu Provincial Center for Disease Control and PreventionNanjingChina
| | - Jessica Lin
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
| | - Zihan Yan
- University of California BerkeleyBerkeleyCAUSA
| | - Erin Wilson
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Willi McFarland
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCAUSA
| |
Collapse
|
19
|
Mburu G, Chhoun P, Chann N, Tuot S, Mun P, Yi S. Prevalence and risk factors of HIV infection among people who inject drugs in Cambodia: findings from a national survey. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:42. [PMID: 31623645 PMCID: PMC6798405 DOI: 10.1186/s13011-019-0232-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Globally, people who inject drugs (PWID) continue to be among the most vulnerable populations to acquire infection of human immunodeficiency virus (HIV). The most recent national survey found that nearly a quarter of PWID in Cambodia were infected with HIV in 2012. The aim of this study is to estimate the current prevalence of and factors associated with HIV infection among PWID in Cambodia. METHODS This national integrated biological and behavioral survey was conducted from June to December 2017. Participants were recruited from the capital city and 11 major provinces using the respondent driven sampling method. Face-to-face interviews were conducted using a structured questionnaire, and blood samples were collected for HIV, syphilis, and hepatitis C virus (HCV) testing. Multiple logistic regression analysis was conducted to identify risk factors for HIV infection. All analyses were estimated with sampling weights that corrected for non-response and sample design. RESULTS A total of 310 PWID participated in the study, and the mean age was 31.8 years (SD = 7.8). The prevalence of HIV was 15.2%. More than half (57.4%) of the HIV-positive participants were co-infected with HCV, and 44.7% were not aware of their HIV status prior to this study. After adjustment for other covariates, HIV infection remained positively associated with being female (AOR = 1.88, 95% CI = 1.03-4.04), being in the older age group of ≥35 (AOR = 2.99, 95% CI 1.33-9.22), being widowed, divorced or separated (AOR = 2.57, 95% CI = 1.04-6.67), living on the streets (AOR = 2.86, 95% CI 1.24-4.37), and HCV infection (AOR = 3.89, 95% CI 1.86-1.15). The HIV infection remained negatively associated with having higher level of formal education of ≥10 years (AOR = 0.44, 95% CI 0.13-0.83) and higher average income of ≥US$200 per month (AOR = 0.20, 95% CI = 0.05-0.74). CONCLUSIONS The prevalence of HIV among PWID in Cambodia remains high, but is reducing compared with the 24.8% reported in the 2012 national survey. Findings from this study provide critical information for tailoring interventions based on identified vulnerabilities and risk factors for HIV. Our findings underline the importance of socio-structural factors in HIV epidemiology among PWID in Cambodia, which require mitigation.
Collapse
Affiliation(s)
- Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK.,Centre for Global Health Policy, University of Sussex, Brighton, UK
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| |
Collapse
|
20
|
Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: A systematic review of the literature. J Am Acad Dermatol 2019; 81:438-447. [DOI: 10.1016/j.jaad.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
|
21
|
Tuot S, Mburu G, Mun P, Chhoun P, Chann N, Prem K, Yi S. Prevalence and correlates of HIV infection among people who use drugs in Cambodia: a cross-sectional survey using respondent driven sampling method. BMC Infect Dis 2019; 19:515. [PMID: 31185925 PMCID: PMC6558681 DOI: 10.1186/s12879-019-4154-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background Most of studies on the relationship between drug use and HIV have focused largely on people who inject drugs. Non-injecting drug use is much more common than injecting drug use, and although it can also predispose people to HIV infection, it is not widely explored. We therefore conducted this study to explore the prevalence of HIV and identify risk factors for HIV infection among people who use non-injecting drugs (PWUD) in Cambodia. Methods This cross-sectional study was conducted in 2017. The Respondent Driven Sampling method was used to recruit the study participants who were interviewed face-to-face using a structured questionnaire. Blood samples were collected for HIV and syphilis testing. A multivariable logistic regression analysis was conducted to identify risk factors associated with HIV infection. Results In total, 1367 PWUD were included in this study, whose mean age was 28.0 (SD = 7.7) years. The majority (95.1%) of the participants used methamphetamine. The prevalence of HIV was 5.7, and 35.2% of the identified HIV-positive PWUD were not aware of their status prior to the survey. After adjustment for other covariates, HIV infection remained significantly associated with being in the age group of ≥35 (AOR = 2.34, 95% CI = 1.04–6.11), having lower level of formal education of ≤ 6 years (AOR = 2.26, 95% CI = 1.04–5.15), living on the streets (AOR = 2.82, 95% CI = 1.10–7.23), perception that their HIV risk was higher as compared to that of the general population (AOR = 3.18, 95% CI = 1.27–8.62), having used injecting drugs in lifetime (AOR = 3.8, 95% CI = 1.36–4.56), and having cuts or sores around the genital area in the past 12 months (AOR = 3.42, 95% CI = 1.09–6.33). Conclusions The prevalence of HIV among PWUD in this study was more than 10 times higher than the prevalence in the general adult population. The findings reveal a higher vulnerability to HIV infection among specific sub-populations of PWUD, such as those who are homeless, who may benefit from tailored interventions that respond to their specific needs. To enhance HIV case finding, stratification of PWUD to facilitate HIV risk profiling based on socio-economic profiles and drug injection history is recommended.
Collapse
Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| |
Collapse
|
22
|
Yi S, Sok S, Chhim S, Chhoun P, Chann N, Tuot S, Mun P, Pantelic M. Access to community-based HIV services among transgender women in Cambodia: findings from a national survey. Int J Equity Health 2019; 18:72. [PMID: 31101106 PMCID: PMC6889562 DOI: 10.1186/s12939-019-0974-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/30/2019] [Indexed: 01/18/2023] Open
Abstract
Background Globally, the prevalence of HIV among transgender women is more than 40 times higher than the prevalence in the general reproductive-age adults. They also face intersecting barriers to health, social, and legal services due to their hidden and stigmatized nature. Despite the particular needs, data regarding the access to services among transgender populations is scant globally. This study aims to identify characteristics of transgender women in Cambodia that may determine their accessibility to community-based HIV services. Methods In the National Biological and Behavioral Survey 2016, a structured questionnaire was used for face-to-face interviews with 1375 sexually active transgender women recruited from the capital city and 12 other provinces using the Respondent-Driven Sampling method. Weighted multivariate regression analysis was conducted to explore factors associated with access to community-based HIV services. Results The mean age of the participants was 25.8 years (SD = 7.1), and 45.0% reported having received at least one community-based HIV service in the past three months. Compared to participants who reported not having been reached by any community-based HIV programs, participants who reported having been reached by the programs were significantly more likely to reside in an urban setting (AOR = 1.41, 95% CI = 1.01–1.96), to have used gender-affirming hormones (AOR = 1.50, 95% CI = 1.17–1.92), to have been tested for HIV in the past six months (AOR = 7.42, 95% CI = 5.78–9.53), and to have been arrested by police or other authorities because of their transgender identity (AOR = 1.55, 95% CI = 1.03–2.33). Participants who reported having been reached by community-based HIV programs were significantly less likely to report being in a receptive role (AOR = 0.34, 95% CI = 0.15–0.82), to use condoms consistently with non-commercial male partners (AOR = 0.72, 95% CI = 0.55–0.94), and to perceive that their co-workers were not supportive regarding their transgender identity (AOR = 0.57, 95% CI = 0.44–0.98). Conclusions Despite the extensive expansion of community-based HIV programs, less than half of transgender women in this national survey had access to the services. Innovative strategies and culturally sensitive interventions should be put in place to reach and respond to the needs of sub-groups of transgender women who are less likely to be reached by the existing traditional approaches.
Collapse
Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Say Sok
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | | | - Pheak Chhoun
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Navy Chann
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Marija Pantelic
- Frontline AIDS, Brighton, UK.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| |
Collapse
|
23
|
Hiransuthikul A, Janamnuaysook R, Sungsing T, Jantarapakde J, Trachunthong D, Mills S, Vannakit R, Phanuphak P, Phanuphak N. High burden of chlamydia and gonorrhoea in pharyngeal, rectal and urethral sites among Thai transgender women: implications for anatomical site selection for the screening of STI. Sex Transm Infect 2019; 95:534-539. [PMID: 30982000 DOI: 10.1136/sextrans-2018-053835] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/16/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Comprehensive data on Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections to guide screening services among transgender women (TGW) are limited. We studied the burden of CT/NG infections in pharyngeal, rectal and urethral sites of Thai TGW and determined missed CT/NG diagnoses if selected site screening was performed. METHODS Thai TGW were enrolled to the community-led test and treat cohort. CT/NG screening was performed from pharyngeal swab, rectal swab and urine using nucleic acid amplification test. CT/NG prevalence in each anatomical site was analysed, along with the relationships of CT/NG among the three anatomical sites. RESULTS Of 764 TGW included in the analysis, 232 (30.4%) had CT/NG infections at any anatomical site, with an overall incidence of 23.7 per 100 person-years. The most common CT/NG infections by anatomical site were rectal CT (19.5%), rectal NG (9.6%) and pharyngeal NG (8.1%). Among 232 TGW with CT/NG infections at any anatomical site, 22%-94.4% of infections would have been missed if single anatomical site testing was conducted, depending on the selected site. Among 668 TGW who tested negative at pharyngeal site, 20.4% had either rectal or urethral infections. Among 583 TGW who tested negative at the rectal site, 8.7% had either pharyngeal or urethral infections. Among 751 TGW who tested negative at the urethral site, 19.2% had either pharyngeal or rectal infections. CONCLUSION Almost one-third of Thai TGW had CT/NG infections. All-site screening is highly recommended to identify these infections, but if not feasible rectal screening provides the highest yield of CT/NG diagnoses. Affordable molecular technologies and/or CT/NG screening in pooled samples from different anatomical sites are urgently needed. TRIAL REGISTRATION NUMBER NCT03580512.
Collapse
Affiliation(s)
| | | | | | | | | | - Steve Mills
- LINKAGES Thailand FHI 360, Bangkok, Thailand
| | - Ravipa Vannakit
- Office of Public Health, US Agency for International Development, Bangkok, Thailand
| | | | | |
Collapse
|
24
|
Yi S, Plant A, Tuot S, Mun P, Chhim S, Chann N, Chhoun P, Brody C. 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. BMC Public Health 2019; 19:326. [PMID: 30894165 PMCID: PMC6427883 DOI: 10.1186/s12889-019-6656-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, 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. METHODS Data 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. RESULTS This 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. CONCLUSIONS This 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.
Collapse
Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Amelia Plant
- Reproductive Rights and Programming Consultant, Cairo, Egypt
| | - Sovannary Tuot
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | | | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, USA
| |
Collapse
|
25
|
Abaasa A, Nash S, Mayanja Y, Price M, Fast PE, Kamali A, Kaleebu P, Todd J. Simulated vaccine efficacy trials to estimate HIV incidence for actual vaccine clinical trials in key populations in Uganda. Vaccine 2019; 37:2065-2072. [PMID: 30857933 DOI: 10.1016/j.vaccine.2019.02.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fisherfolks (FF) and female sex workers (FSW) in Uganda could be suitable key populations for HIV vaccine efficacy trials because of the high HIV incidence and good retention in observational cohorts. However, the observed HIV incidence may differ in participants who enroll into a trial. We used simulated vaccine efficacy trials (SiVET) nested within observational cohorts in these populations to evaluate this difference. METHODS SiVETs were nested in two observational cohorts (Jul 2012-Apr 2014 in FF and Aug 2014-Apr 2017 in FSW). From Jan 2012 all observational cohort participants (aged 18-49 years) presenting for quarterly visits were screened for enrolment into SiVETs, until 572 were enrolled. Those not enrolled (screened-out or not screened) in SiVET continued participation in the observational cohorts. In addition to procedures in the observational cohorts (HIV testing & risk assessment), SiVET participants were given a licensed Hepatitis B vaccine mimicking a schedule of a possible HIV vaccine, and followed-up for 12 months. FINDINGS In total, 3989 participants were enrolled into observational cohorts (1575 FF prior to Jul 2012 and 2414 FSW prior to Aug 2014). Of these 3622 (90.8%) returned at least once, 672 (44.1%) were screened and 572 enrolled in the SiVETs. HIV incidence pre SIVETs was 4.5/100 person years-at-risk (pyar), 95%CI (3.8-5.5). HIV incidence in SiVET was 3.5/100 pyar, (2.2-5.6) and higher in those not enrolled in the SiVET, 5.9/100 pyar, (4.3-8.1). This difference was greatest among FF. In the 12 months post-SIVET period (FF, May 2014-Apr 2015 and FSW, May 2017-Apr 2018), the HIV incidence was 3.7/100 pyar, (2.5-5.8). INTERPRETATION HIV incidence was lower in SiVET participants compared to non-SiVET. This difference was different for the two populations. Researchers designing HIV efficacy trials using observational cohort data need to consider the potential for lower than expected HIV incidence following screening and enrolment.
Collapse
Affiliation(s)
- Andrew Abaasa
- MRC/UVRI & LSTHM Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK.
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Yunia Mayanja
- MRC/UVRI & LSTHM Uganda Research Unit, Entebbe, Uganda
| | - Matt Price
- International AIDS Vaccine Initiative, New York, USA; University of California at San Francisco, Department of Epidemiology and Biostatistics, San Francisco, USA
| | - Patricia E Fast
- International AIDS Vaccine Initiative, New York, USA; Pediatric Infectious Diseases, School of Medicine, Stanford University, USA
| | | | | | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
26
|
Characteristics and HIV epidemiologic profiles of men who have sex with men and transgender women in key population-led test and treat cohorts in Thailand. PLoS One 2018; 13:e0203294. [PMID: 30161226 PMCID: PMC6117046 DOI: 10.1371/journal.pone.0203294] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
Men who have sex with men (MSM) and Transgender Women (TGW) in Thailand contribute to more than half of all new HIV infections annually. This cross-sectional study describes epidemiologic profiles of these key populations (KP) in Key Population-led Test and Treat study. Baseline data were collected using self-administered questionnaires and HIV/STI testing from MSM and TGW aged ≥18 years enrolled in a cohort study in six community sites in Thailand between October 2015 and February 2016. Factors associated with HIV prevalence were determined by logistic regression. TGW in the cohorts had lower education and income levels than MSM. TGW also engaged in sex work more, though similar proportions between MSM and TGW reported to have multiple sexual partners and STI diagnosis at baseline. HIV prevalence was 15.0% for MSM and 8.8% for TGW in the cohorts. HIV prevalence among TGW was more associated with sociodemographic characteristics, whereas factors related to behavioral risks were determined to be associated with HIV prevalence among MSM. TGW and MSM in the cohorts also had high prevalence of STI. Key Population-driven HIV services are able to capture harder-to-reach key populations who are at heightened risk for HIV.
Collapse
|
27
|
Yi S, Tuot S, Chhoun P, Pal K, Chhim K, Ngin C, Brody C. Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study. PLoS One 2018; 13:e0198095. [PMID: 29965968 PMCID: PMC6028079 DOI: 10.1371/journal.pone.0198095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/14/2018] [Indexed: 12/05/2022] Open
Abstract
Background In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities. Methods Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A logistic regression model was constructed to identify independent factors associated with recent HIV testing. Results Data were collected from 667 FEWs with a mean age of 25.6 (SD = 5.5). Of total, 81.7% reported ever having had an HIV test, and 52.8% had at least one test in the past six months. After adjustment for other covariates, factors independently associated with recent HIV testing included living in Phnom Penh (AOR = 2.17, 95% CI = 1.43–3.28), having received HIV education in the past six months (AOR = 3.48, 95% CI = 2.35–5.15), disagreeing with a statement that ‘I would rather not know if I have HIV’ (AOR = 2.15, 95% CI = 1.41–3.30), agreeing with a statement that ‘getting tested for HIV helps people feel better’ (AOR = 0.32, 95% CI = 0.13–0.81) and not using a condom in the last sexual intercourse with a non-commercial partner (AOR = 0.48, 95% CI = 0.26–0.88). Conclusions FEWs with greater knowledge and positive attitudes towards HIV testing got tested for HIV more frequently than those with lesser knowledge and less positive attitudes. These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.
Collapse
Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States of America
- * E-mail:
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Kolab Chhim
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Chanrith Ngin
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States of America
| |
Collapse
|
28
|
Yi S, Tuot S, Chhim S, Chhoun P, Mun P, Mburu G. Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016. Int J Ment Health Syst 2018; 12:24. [PMID: 29853990 PMCID: PMC5975411 DOI: 10.1186/s13033-018-0206-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background Transgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia. Methods This cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms. Results Of total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22-3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29-2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02-2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50-3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15-2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64-2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61-2.68). Conclusions Transgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.
Collapse
Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.,2Center for Global Health Research, Touro University California, Vallejo, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Phalkun Mun
- 4National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Gitau Mburu
- 5Division of Health Research, Lancaster University, Lancaster, UK
| |
Collapse
|
29
|
Chhim S, Macom J, Pav C, Nim N, Yun P, Seng S, Chhim K, Tuot S, Yi S. Using risk-tracing snowball approach to increase HIV case detection among high-risk populations in Cambodia: an intervention study. BMC Infect Dis 2017; 17:689. [PMID: 29047354 PMCID: PMC5648448 DOI: 10.1186/s12879-017-2790-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early HIV diagnosis and initiation onto antiretroviral therapy may prevent ongoing spread of HIV. Risk Tracing Snowball Approach (RTSA) has been shown to be effective in detecting new HIV cases in other settings. The main objective of this study is to evaluate the effectiveness of RTSA in increasing the rate of newly identified HIV cases among high-risk populations. Our second objective was to evaluate the effectiveness of RTSA, as compared to the walk-in group, in increasing the number of HIV tests and early case detection. METHODS This study was conducted from April 1 to September 30, 2016 at two NGO clinics in Phnom Penh, Cambodia. Respondent driven sampling method was adapted to develop RTSA to reach high-risk populations, including key populations and the general population who have social connections with key populations. Bivariate and multivariate logistic regression analyses were conducted. RESULTS During the implementation period, 721 clients walked in for HIV testing (walk-in group), and all were invited to be seeds. Of the invited clients, 36.6% agreed to serve as seeds. Throughout the implementation, 6195 coupons were distributed to seeds or recruiters, and resulted in 1572 clients visiting the two clinics with coupons (RTSA group), for a coupon return rate of 25.3%. The rate of newly identified HIV cases among the RTSA group was significantly lower compared to that in walk-in group. However, the highest number of newly identified HIV cases was found during the implementation period, compared to both pre- and post-implementation period. Although statistically not significant, the mean CD4 count of newly identified HIV cases detected through RTSA was almost 200 cells/mm3 higher than that in the walk-in group. CONCLUSIONS Although the rate of newly identified HIV cases among the RTSA group was lower than that in the walk-in group, the inclusion of RTSA in addition to the traditional walk-in method boosted new HIV case detection in the two participating clinics. A higher mean CD4 count for the RTSA group may reveal that RTSA may be able to detect HIV cases earlier than the traditional walk-in approach. Further research is needed to understand whether RTSA is a cost-effective intervention to prevent ongoing spread of the HIV among high-risk populations in Cambodia.
Collapse
Affiliation(s)
- Srean Chhim
- FHI 360, Phnom Penh, Cambodia. .,Boeung Keng Kang III, No. 3, Street 330, Chamkarmon, Phnom Penh, Cambodia.
| | - John Macom
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
| | | | | | - Phearun Yun
- Chhouk Sar Association, Phnom Penh, Cambodia
| | | | - Kolab Chhim
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA
| |
Collapse
|