Factors associated with HIV Prevalence and Sexually Transmitted Infection Risk Behaviors among Transgender in Thailand, 2014

Abstract

Background: The surveillance on risk behaviors associated with human immunodeficiency virus (HIV) infection among transgenders (TG) has been initiated since 2007 as HIV prevalence among TG has been increasingly reported in Thailand. Integrated biological and behavioral surveillance (IBBS) was initiated by Bureau of Epidemiology during 2014 in order to obtain more representative men who have sex with men (MSM) population in the provinces. This surveillance aims to monitor trends of HIV and sexually transmitted infections (STI), determine the associated risk behaviors, and identify the relationship between the risk factors and HIV infection.
Methods: A serial cross–sectional survey was conducted in 5 provinces. Venue day time sampling (VDTS) was used with mapping of TG meeting areas. Palmtop assisted self–interview (PASI) was done with self-administered questionnaires, and urine and oral fluid samples were collected and tested for HIV antibody, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Univariate and multivariate logistic regression were employed to determine the association between characteristics of TG and HIV infection.
Results: Total 916 TGs were included in the analyses, with mean age of 25.1 years and 69.7% as single status. The highest HIV prevalence was 16.6% in Chonburi. STI prevalence for both CT and NG were the highest in Chiang Mai, with 5.3% CT and 1.3% NG in 2014. About 88% of TG reported always having safe sex by wearing condom during anal sex, and the highest percentage was found in Phuket. HIV positive results were associated with knowing HIV result before participation in this study (OR = 5.33, 95% CI = 1.53-18.66), using drugs before anal sex (OR = 1.79, 95% CI = 1.04-3.16), having high risk for self-estimation (OR = 1.69, 95% CI = 1.12-2.55), over 24 years of age (OR = 1.46, 95% CI = 1.18-1.79), and living alone (OR = 1.78, 95% CI = 1.14-2.80). Multivariate analysis showed that knowing HIV result before participation in study (AOR = 5.50, 95% CI = 1.42-21.34) and over 24 years of age (AOR = 1.60, 95% CI = 1.01-2.54) were associated with HIV positive results.
Discussions and Conclusions: The results showed that surveillance on associated risk behaviors and HIV prevalence among TGs effectively determined high HIV prevalence. Increasing sample sizes had effects on HIV infection rate and provided more precise results than the previous surveillance system. TGs aged 25 years or less have higher risk behavior than those who were over 25 since most of them did not wear condom during anal sex. Consequently, Interventions for condom use among TGs should be promoted. HIV/AIDS knowledge among TGs based on GARP indicators revealed that all five provinces provided the correct answers lower than GARP. Using drugs before anal sex related to HIV infection. Including, awareness of their HIV status associated with HIV positive result, even though the majority of TGs never have been testing for HIV/STI over the past years. Annual health check-up service and health care coverage should be provided for TGs, which would also facilitate identifying more HIV infection in Thailand.