Correlates of HIV infection among transgender women in two Chinese cities.

BACKGROUND: In an era when HIV transmission has been on the rise among men who have sex with men (MSM), transgender women may play a considerable role in China's current HIV epidemic as a potential "bridge" of HIV transmission between homosexual and heterosexual populations. We sought to understand the risk behaviours and factors associated with HIV infection among transgender women in two cities in China. METHODS: From January to December 2016, we recruited transgender women with the help of community-based organizations (CBOs) through a wide range of methods, including snowball sampling. After recruitment, we asked participants to fill out a structured questionnaire including questions about socio-demographics, sexual behaviours, condom use, substance use and uptake of health care services. HIV infection status was determined by using two different rapid testing reagents. RESULTS: Among 498 subjects enrolled in this study, 233 were from Shanghai and 265 were from Tianjin. The median age was 30 years (range: 18-68; IQR: 24-33). Of them, 337 (67.7%) preferred feminine dress, 13 (2.6%) had undergone transsexual operation and 68 (13.7%) had used hormones for transition purposes. Nearly half (45.6%) reported having regular partners, and 351 (70.5%) had casual partners. Regarding condom use, 81.5% reported not always using condoms with stable partners, and 70.9% reported not using condoms with casual partners. Twenty-five (5.0%) had a history of buying sex and fifty-one (10.2%) had a history of selling sex in the past three months. A total of 200 (40.2%) participants had used at least one kind of controlled substance in the past six months. The most commonly used substances were amyl nitrates (rush popper) (99.5%) and 5-MeO-DiPT (20.0%). Among rush popper users, 170 (85.4%) reported always having sex while on the drug, and 177 (88.9%) reported increased sexual pleasure after using the drug. The HIV infection risk factors identified in our study were being located in Shanghai (aOR = 9.35, 95% CI = 3.89-22.49), selling sex in the past three months (aOR = 3.44, 95% CI = 1.31-9.01), and substance use in the past six months (aOR = 5.71, 95% CI = 2.63-12.41). CONCLUSIONS: Transgender women bear a high HIV burden in the two Chinese cities. Those involved in commercial sex tended to have inconsistent condom use, leading to high risk of HIV infection. Substance use was an independent risk factor of HIV infection by increasing sexual activities and unprotected sex, which indicated an aggravated and complex situation with possible interacting syndemic factors that could cumulatively facilitate sexual risk behaviours and HIV infection in transgender women. There is an urgent need for innovative and appropriate HIV prevention programmes targeting this unique population. Efforts should be made to provide them with tailored services including persuasive communication on consistent condom use, substance use counselling and related referral services, all with the goal of reducing HIV epidemic among transgender women.

[Survey on recent infection of human immunodeficiency virus among men who have sex with men in Tianjin during 2008 - 2009].

OBJECTIVE: To study the situation of HIV infections among men who have sex with men (MSM) in Tianjin during 2008 - 2009 and to provide reasonable evidence for intervention strategy. METHODS: Transect investigations in MSM were conducted three times during 2008 - 2009. Blood samples were collected and detected to identify the recent HIV infection with IgG-capture BED-enzyme immunoassay (BED-CEIA) before HIV incidence was estimated. RESULTS: 1799 specimens were tested and the HIV prevalence rates of each study were 6.7%, 8.6% and 6.2%, while the incidence rates were 2.7%, 2.5% and 2.8%, respectively. The estimated incidence rates among these testees were 5.36% and 5.52% per year in 2008 and 2009. RESULTS: of this study showed that the HIV incidence stabilized at high level among MSM in Tianjin, calling for the effective interventions be taken for HIV/AIDS control and prevention.