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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e1002422
JournalPLoS Medicine
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2017

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Transgender Persons
Cross-Sectional Studies
HIV
Psychology
Sexual Behavior
Odds Ratio
HIV Infections
Africa South of the Sahara
Lesotho
Swaziland
Logistic Models
Togo
Gambia
Depression
Burkina Faso
Malawi
Law Enforcement
Senegal
Sampling Studies
Rape

ASJC Scopus subject areas

  • Medicine(all)

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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. / 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.

In: PLoS Medicine, Vol. 14, No. 11, 01.11.2017, p. e1002422.

Research output: Contribution to journalArticle

Poteat, T, Ackerman, B, Diouf, D, Ceesay, N, Mothopeng, T, Odette, KZ, Kouanda, S, Ouedraogo, HG, Simplice, A, Kouame, A, Mnisi, Z, Trapence, G, van der Merwe, LLA, Jumbe, V & Baral, S 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, vol. 14, no. 11, pp. e1002422. https://doi.org/10.1371/journal.pmed.1002422
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. / 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. In: PLoS Medicine. 2017 ; Vol. 14, No. 11. pp. e1002422.
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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), C{\^o}te 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.",
author = "Tonia Poteat and Benjamin Ackerman and Daouda Diouf and Nuha Ceesay and Tampose Mothopeng and Odette, {Ky Zerbo} and Seni Kouanda and Ouedraogo, {Henri Gautier} and Anato Simplice and Abo Kouame and Zandile Mnisi and Gift Trapence and {van der Merwe}, {L. Leigh Ann} and Vicente Jumbe and Stefan Baral",
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TY - JOUR

T1 - HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries

T2 - A cross-sectional analysis

AU - Poteat, Tonia

AU - Ackerman, Benjamin

AU - Diouf, Daouda

AU - Ceesay, Nuha

AU - Mothopeng, Tampose

AU - Odette, Ky Zerbo

AU - Kouanda, Seni

AU - Ouedraogo, Henri Gautier

AU - Simplice, Anato

AU - Kouame, Abo

AU - Mnisi, Zandile

AU - Trapence, Gift

AU - van der Merwe, L. Leigh Ann

AU - Jumbe, Vicente

AU - Baral, Stefan

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

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