HIV, syphilis and hepatitis B prevalence, related risk behaviours and correlates of condom use among transgender women in two cities in Sri Lanka: findings from respondent-driven sampling surveys
Jelena Barbaric
A C , Ivana Bozicevic A , Ariyaratne Manathunge B , Chathrini Gajaweera B and Sriyakanthi Beneragama B
+ Author Affiliations
- Author Affiliations
A World Health Organization Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Zagreb, Croatia.
B National STD/AIDS Control Program, Ministry of Health, Colombo, Sri Lanka.
C Corresponding author. Email: jelena.barbarich@gmail.com
Sexual Health 18(4) 311-318 https://doi.org/10.1071/SH21061
Submitted: 21 March 2021 Accepted: 6 May 2021 Published: 27 August 2021
Abstract
Background: Biobehavioural data on transgender women (TGW) are limited globally. Methods: We used data collected as part of the 2017–18 National Integrated HIV Biobehavioural Survey, which included 254 TGW in Colombo and 252 in Jaffna, for structured questionnaire interviews and biological testing. We performed multivariable logistic regression analysis to explore factors associated with condom use. Results: We found low HIV prevalence in Colombo (0.6%) and no HIV infections in Jaffna. TGW in Colombo had higher positivity on the Treponema pallidum-particle agglutination test (2.5%) compared with TGW in Jaffna (0.4%). We found no hepatitis B infections. In both cities, <25% of TGW have comprehensive knowledge about HIV prevention. In Colombo 54.4%, but only 21.4% of TGW in Jaffna, have ever been tested for HIV. Drug-injecting behaviours are uncommon in both cities (prevalence <1%), whereas 7.4% reported sharing equipment for injecting feminising hormones in Colombo. Greater proportions of TGW in Colombo compared with Jaffna used condom at last sex (82.3% vs 37.7%). Multivariable analysis showed lower odds of condom use at last sex in TGW aged >30 years and those who did not test for HIV in the past 12 months in Colombo, and for TGW with higher income in Jaffna, TGW not visiting outdoor sites to find partners, and TGW who sold sex. Conclusions: Current burden of HIV, syphilis and hepatitis B among TGW in Sri Lanka is low. Although risk behavioural patterns vary between the cities, a substantial sexually transmitted infection vulnerability is a common denominator, calling for strengthening of the capacity to respond to specific TGW needs.
Keywords: HIV/AIDS, STIs, sex work, risk behaviours, Asia, Sri Lanka, transgender women, hidden populations.
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