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© 2016. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Transgender women are at high risk for the acquisition and transmission of HIV. However, there are limited empiric data characterizing HIV-related risks among transgender women in sub-Saharan Africa. The objective of these analyses is to determine what factors, including sexual behaviour stigma, condom use and engagement in sex work, contribute to risk for HIV infection among transgender women across three West African nations.

Methods

Data were collected via respondent-driven sampling from men who have sex with men (MSM) and transgender women during three- to five-month intervals from December 2012 to October 2015 across a total of six study sites in Togo, Burkina Faso and Côte d'Ivoire. During the study visit, participants completed a questionnaire and were tested for HIV. Chi-square tests were used to compare the prevalence of variables of interest between transgender women and MSM. A multilevel generalized structural equation model (GSEM) was used to account for clustering of observations within study sites in the multivariable analysis, as well as to estimate mediated associations between sexual behaviour stigma and HIV infection among transgender women.

Results

In total, 2456 participants meeting eligibility criteria were recruited, of which 453 individuals identified as being female/transgender. Transgender women were more likely than MSM to report selling sex to a male partner within the past 12 months (p<0.01), to be living with HIV (p<0.01) and to report greater levels of sexual behaviour stigma as compared with MSM (p<0.05). In the GSEM, sexual behaviour stigma from broader social groups was positively associated with condomless anal sex (adjusted odds ratio (AOR)=1.33, 95% confidence interval (CI)=1.09, 1.62) and with selling sex (AOR=1.23, 95% CI=1.02, 1.50). Stigma from family/friends was also associated with selling sex (AOR=1.42, 95% CI=1.13, 1.79), although no significant associations were identified with prevalent HIV infection.

Conclusions

These data suggest that transgender women have distinct behaviours from those of MSM and that stigma perpetuated against transgender women is impacting HIV-related behaviours. Furthermore, given these differences, interventions developed for MSM will likely be less effective among transgender women. This situation necessitates dedicated responses for this population, which has been underserved in the context of both HIV surveillance and existing responses.

Details

Title
Characterizing the HIV risks and potential pathways to HIV infection among transgender women in Côte d'Ivoire, Togo and Burkina Faso
Author
Stahlman, Shauna 1 ; Liestman, Benjamin 1 ; Ketende, Sosthenes 1 ; Seni Kouanda 2 ; Ky-Zerbo, Odette 3 ; Lougue, Marcel 3 ; Diouf, Daouda 4 ; Anato, Simplice 5 ; Tchalla, Jules 6 ; Bamba, Amara 7 ; Drame, Fatou Maria 4 ; Ezouatchi, Rebecca 7 ; Abo Kouamé 8 ; Baral, Stefan D 1 

 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA 
 Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso; Institut Africain de Santé Publique, Ouagadougou, Burkina Faso 
 Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso 
 Enda Santé Senegal, Dakar, Sénégal; 
 Arc-en-ciel, Lomé, Togo 
 Espoir Vie, Lomé, Togo 
 Enda Santé, Abidjan, Côte d'Ivoire 
 Programme National de Lutte contre le Sida, Ministère de la Santé et de la Lutte contre le Sida, Abidjan, Côte d'Ivoire 
Section
Research Article
Publication year
2016
Publication date
Jul 2016
Publisher
John Wiley & Sons, Inc.
e-ISSN
1758-2652
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3067612927
Copyright
© 2016. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.