Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal

Abstract

Background Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. Methods In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma. Results Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67–0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01–1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20–0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03–1.78; p = 0·03; aPR 1.45; 95% CI 1.03–2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work. Conclusions Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.

Interseccionalidade e transexualidade no processo discriminatório: uma revisão integrativa [Intersectionality and transsexuality in the process of discrimination: an integrative review] [Interseccionalidad y transexualidad en el proceso discriminatorio: una revisión integradora]

“…Em todo o mundo mulheres trans experimentam formas cruzadas de discriminação devido a suas posições sociais marginalizadas, estruturalmente produzidas nas intersecções de cor, etnia, cidadania, gênero, sexualidade, idade, deficiência e classe [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . O Brasil lidera o ranking mundial de assassinatos de pessoas trans, com um assassinato a cada 48 horas 7 , tornando esta evidência ainda mais preocupante no cenário brasileiro.…”

“…Todas as categorias de violência foram mais altas para a população de pessoas trans. Estimativas mostram que mulheres trans negras e latinas representam quase a totalidade de todas as vítimas de homicídio transgênero nos Estados Unidos, onde estas também são assediadas regularmente até pela polícia 17,20 .…”

Experiences of key populations in getting and sharing HIV and AIDS-related information: A descriptive phenomenological study

“…Condom use is still below (61-73%) an optimal level in key populations like female sex workers, men who have sex with men, and transgender who received educational interventions (Deuba et al, 2020;National Centre for AIDS and STD Control [NCASC], 2018). In addition, there is a greater prevalence of condomless receptive anal intercourse among male sex with male and transgender people (Wilson et al, 2021). A study by Kakchapati et al (2018) revealed that only about 29% of FSWs had knowledge about HIV and it was not associated with safe sexual practices.…”

“…A study by Kakchapati et al (2018) revealed that only about 29% of FSWs had knowledge about HIV and it was not associated with safe sexual practices. Some recent studies (Shrestha et al, 2017;Kakchapati et al, 2018;NCASC, 2018;Deuba et al, 2020;Wilson et al, 2021) have indicatedthat despite the decades of targeted interventions including IEC activities against HIV and AIDS in Nepal, risk behaviors of key populations have not changed as expected and trend of the concentrated epidemic has not declined satisfactorily. This alarming situation demands research to explore the major means and modes of communication through which key populationsfrequently use to get and share HIV and AIDS-related information.…”

“…Most of the previous studies (Paudel et al, 2016;Shrestha et al, 2017;Kakchapati et al, 2018;NCASC, 2018;Deuba et al, 2020;Storm et al, 2020;Wilson et al, 2021) on HIV and AIDS-related communication in Nepal have used survey design, systematic review, and metaanalysis, but none has used a phenomenological approach. Most of these previous studies have focused on the general audience, young people, migrant workers, and students; while nominal studies have been carried out in the key populations, such as sexual minorities and female sex workers.…”