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HIV Prevalence and Behavioral and Psychosocial Factors among Transgender Women and Cisgender Men Who Have Sex with Men in 8 African Countries: A Cross-Sectional Analysis

Citation

Poteat, Tonia; Ackerman, Benjamin; Diouf, Daouda; Ceesay, Nuha; Mothopeng, Tampose; Odette, Ky-Zerbo; Kouanda, Seni; Ouedraogo, Henri Gautier; Simplice, Anato; & Kouame, Abo, et al. (2017). HIV Prevalence and Behavioral and Psychosocial Factors among Transgender Women and Cisgender Men Who Have Sex with Men in 8 African Countries: A Cross-Sectional Analysis. PLOS Medicine, 14(11), e1002422. PMCID: PMC5675306

Abstract

INTRODUCTION: Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.
METHODS AND FINDINGS: Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.
CONCLUSIONS: In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.

URL

http://dx.doi.org/10.1371/journal.pmed.1002422

Reference Type

Journal Article

Year Published

2017

Journal Title

PLOS Medicine

Author(s)

Poteat, Tonia
Ackerman, Benjamin
Diouf, Daouda
Ceesay, Nuha
Mothopeng, Tampose
Odette, Ky-Zerbo
Kouanda, Seni
Ouedraogo, Henri Gautier
Simplice, Anato
Kouame, Abo
Mnisi, Zandile
Trapence, Gift
van der Merwe, L. Leigh Ann
Jumbe, Vicente
Baral, Stefan D.

PMCID

PMC5675306