Prevalence of Human Immunodeficiency Virus and Sexually Transmitted Infections Among Cisgender and Transgender Women Sex Workers in Greater Kuala Lumpur, Malaysia: Results From a Respondent-Driven Sampling Study

Abstract

Background Sex workers face a disproportionate burden of HIV and sexually transmitted infections (STI) worldwide. For cisgender women sex workers (CWSW), global HIV prevalence is over 10%, while transgender women sex workers (TWSW) face an HIV burden of 19%–27%. Methods We used respondent-driven sampling to recruit 492 sex workers, including CWSW (n=299) and TWSW (n=193) in Greater Kuala Lumpur, Malaysia. Participants completed an in-depth survey and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Sample characteristics stratified by gender identity and interview site are presented. Bivariate analyses comparing CWSW and TWSW were conducted using independent samples t-tests for continuous variables and chi-squared tests for categorical variables. Results Pooled HIV prevalence was high (11.7%; 95%CI 8.8–14.5), and was similar for CWSW (11.1%) and TWSW (12.4%). Rates of syphilis 25.5% (95%CI 21.6–29.5), C. trachomatis (14.8%; 95%CI 11.6–18.0) and N. gonorrhoeae (5.8%; 95%CI 3.7–7.9) were also concerning. Both groups reported lifetime HIV testing (62.4%), but CWSW were less likely to have ever been HIV tested (54.5%) than TWSW (74.6%). Median time since last HIV test was 24 months. Previous screening for STI was low. Inconsistent condom use and drug use during sex work were not uncommon. Conclusions High HIV and STI prevalence, coupled with infrequent HIV and STI screening, inconsistent condom use, and occupational drug use, underscore the need for expanded HIV and STI prevention, screening, and treatment efforts among CWSW and TWSW in Malaysia.

Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review

“…This review includes 25 studies that met our inclusion criteria. 7,10,11, Details regarding these studies and their characteristics can be seen in Table 1. The size of studies, including transgender women, varied from 63 to 13,154 people (median, 786) and those including transgender men ranged from 25 to 2364 people (median, 336).…”

“…four were focused on commercial sex workers. 7,42,47,48 In fact, of the studies investigating transgender women, 4 (16%) exclusively evaluated commercial sex workers. Research involving transgender populations has moved away from grouping commercial sex workers and transgender women into the same study population, with most of these studies being conducted in 2013 or earlier.…”

“…In five of the studies where gonorrhea or chlamydia testing was reported, any positive test of any site qualified as diagnostic of that infection, but sites were not specified in their reporting. 7,[30][31][32]37 The overall prevalence of gonorrhea ranged from 2.1% to 19.1% in transgender women and 0% to 10.5% in transgender men. For chlamydia, prevalence ranged from 2.7% to 24.7% in transgender women and from 1.2% to 11.1% in transgender men.…”

“…4,5 Particularly well studied is HIV in the trans feminine population. [6][7][8][9][10] For transgender women, HIV rates are disproportionately high compared to other high-risk groups like men who have sex with men (MSM) and sexual partners of people living with HIV. 11 This is hypothesized to be related to high-risk sexual behaviors such as commercial sex work, unprotected receptive anal intercourse, and multiple casual sex partners, which have been described as relatively common among transgender women.…”

Epidemiology of gonorrhoea: a global perspective

“…98 Recently published estimates of urogenital gonorrhoea positivity among STI clinic attending-female SWs (FSWs) range from 2.7% among women in England in 2011 (n = 2534) to 21.2% among those in Guatemala in 2012 (n = 3213). 25,[99][100][101][102][103] Data on prevalence of rectal and pharyngeal gonorrhoea among FSWs are sparse, but a large retrospective cohort study of 18 475 FSWs attending 42 sexual health clinics in Australia during 2009-15 reported an overall incidence of urogenital gonorrhoea of 1.4 per 100 PY, pharyngeal gonorrhoea was 3.6 per 100 PY, and rectal gonorrhoea was 0.3 per 100 PY. 104 The annual incidence of each increased during the analytic period, including from 1.6 per 100 PY in 2009 to 4.9 per 100 PY in 2015 for pharyngeal gonorrhoea.…”