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Sexual risk behavior and HIV among Male to female transgendered people accessing VCT services in Mumbai, India. Sameer Kumta *, Mark Lurie *, Alka Gogate.

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Presentation on theme: "Sexual risk behavior and HIV among Male to female transgendered people accessing VCT services in Mumbai, India. Sameer Kumta *, Mark Lurie *, Alka Gogate."— Presentation transcript:

1 Sexual risk behavior and HIV among Male to female transgendered people accessing VCT services in Mumbai, India. Sameer Kumta *, Mark Lurie *, Alka Gogate ¥, Hemangi Jerajani † Sherry Weitzen *, Ashok Row Kavi ¶, Vivek Anand ¶, Harvey Makadon ‡, Kenneth Mayer ** * Brown University, Providence, Rhode Island ¥ UNAIDS Project, Mumbai, India † Department of Dermatology, LTM Medical College and Hospital, Mumbai, India @ Department of Obstetrics and Gynecology and Community Health, Brown Medical School, Rhode Island ¶ The Humsafar Trust, Mumbai, India ‡ Harvard Medical School, Boston, MA ** The Miriam Hospital, Brown University, Providence, RI.

2 Transgenders - “Hijras or Alis” Biological men who prefer to be considered as women Marginalized, close knit group, dress up as women, may/may not be castrated Estimated number - 5000 in Mumbai, 50,000 all over India NACO recognizes that MSM are at risk for HIV, and funds prevention efforts In India there has been traditional recognition of gender divergent roles, but social stigma as well

3 The Humsafar Trust – Mumbai, India Community based organization October 1995 - Drop in center, library and cafeteria 1999 – VCTC was established under aegis of MDACS (Mumbai Districts AIDS Control Society) 2000 – Sentinel surveillance center for HIV testing and counseling in Mumbai Outreach to 7500 new MSM and 50,000 clients every year Extended VCT services to 8000 clients in the past 6 years

4 Study Methods 205 consenting transgendered people attending the VCTC at the Humsafar Trust - January 2003 through December 2004 Pre test counseling, Counselor administered behavioral questionnaire Questionnaire – demographics, reason for testing, sexual risk behavior and condom use Blood drawn – VDRL & HIV rapid tests (NACO guidelines) Clinical exam and medications for STIs

5 Study Methods Post test counseling on receiving results Data entered in Epi Info and secondary data analysis in STATA TM 9.1 Pearson’s Chi square test or Fischer’s test of independence were performed We report on 183 transgendered people who accessed the VCT

6 DEMOGRAPHICS (N=183) 61.7% were between 18 – 24 years of age 81.4% were not castrated 67.2% reported sex work as their occupation 74.8% were reported by counselors as accessing VCT services on account of high risk sexual behavior Almost all 182 (99.5) preferred males as partners

7 SEXUAL RISK (N=183) 84.7% reported preferred to engage in anal receptive sex Perceived risk of HIV –54.6% said no risk –30.6% said did not know if they were at risk for HIV 76.5% reported 5 or more sexual partners in the past 6 months 51.9% reported 10 or more partners in the past 1 month 39.4% never used condoms with regular partner during Anal sex in their lifetime

8 HIV AND STI PREVALENCE (N=183) Clinical DiagnosisSTIs % 27.9 VDRL test for Syphilis (> 1 : 8) Reactive13.1 HIV seroprevalencePositive39.9 Results obtainedYes45.4

9 Sex work (* p<0.05, ** p < 0.001) PredictorsSex work n=123,(%) Other occupations n=60,(%) Non castrated Tg Castrated Tg 107 (86.9) 16 (13.0) 42 (70.0) 18 (30.0)* Age groups: 18 – 19 yrs 20 – 24 yrs 25 – 29 yrs > 30 years 24 (19.5) 65 (52.9) 22 (17.9) 12 (9.8) 6 (10.0) 18 (30.0) 18 (30.0)** Partners in 1 mth: <5 > =5 24 (19.5) 99 (80.5) 53 (88.3) 7 (11.7)**

10 Tgs and other MSM (* p<0.05, ** p < 0.001) PredictorsTg; N=183,(%) Columns MSM; N=831,(%) Columns Employment: Unemployed/unskilled Skilled/ Professional Sex work 56 (30.6) 2 (1.1) 123 (67.2) 293 (35.2) 489 (58.8) 27 (3.3)** Marital Status: Partnered Not partnered 27 (14.8) 156 (85.2) 189 (22.7) 642 (77.3)* Preference of partner: Male Transgender Female Male and Female 180 (98.4) 2 (1.0) 1 (0.6) 0 445 (53.6) 26 (3.1) 161 (19.4) 199 (23.9)**

11 Discussion Tg’s accessing VCT services young in age, reported sex work as occupation, tested for HIV on account of high risk behavior. Sex work as occupation –lack access to mainstream employment –waning of demand for traditional role of transgenders Preference of receptive anal sex –Preference for men who take an insertive role (panthis) –Having a male penetrative partner forms an important part of the “hijra” identity Access VCT services due to high risk behavior, yet did not perceive risk for HIV – need HIV prevention interventions

12 Discussion Did not report injection drug use as a risk factor High rates of clinically diagnosed STIs, syphilis seropositivity and HIV prevalence; rates did not differ among those who reported sex work as occupation and those who did not – high risk is generalized in this population High rates of clinically diagnosed STIs, reactive syphilis serology as compared to other MSM – need for culturally sensitive interventions among transgendered people Tg did not return for results –Low risk perception of HIV acquisition –Socially marginalized status (minimal health care access)

13 Limitations Convenience sample – cannot be generalized Cross sectional – no causal inference Some underreport of risk behavior and over report of condom use albeit minimal Recall bias – number of partners in past 6 months No confirmatory tests for syphilis – no reports of yaw, pinta from Mumbai

14 Acknowledgements Miriam Hospital/Brown University Grant 5D43TW000237 –13 Mumbai Districts AIDS Control Society/NACO FHI – Impact Murugesan Subramaniam for meticulous data entry Outreach, counseling, laboratory and clinical staff at the Humsafar Trust


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