HIV Infection, risk factors and health services use among male-to-female transgender sex workers: a cross-sectional study in Portugal

ABSTRACT

Male-to-female transgender sex workers (TSW) have been identified as a key population at risk for HIV. This study examined risk behaviors and HIV prevalence among TSW, and described health services use. A participatory cross-sectional survey was conducted with 125 TSW recruited in locations and networks where sex workers congregate. HIV-risk behaviors were common among participants. Inconsistent condom use with clients in the previous month was reported by 12.0% of participants and was associated with Portuguese nationality, inconsistent condom use with non-paying partners and not been reached by HIV prevention programs in the previous year. Ever use of psychoactive substances was reported by 61.6% of participants and was associated with being non-employed, doing full-time sex work, having higher number of non-paying partners and having never used health services. Also, ever use of psychoactive substances was negatively associated with older age and Portuguese nationality. About 34% of the participants reported having not been tested in the previous 12 months; 20.2% never used the health services. Overall, 14.9% (95%CI: 8.0–21.0%) reported being HIV-positive. Of those, 22.2% (95%CI: 1.0–43.5%) had unprotected sex with clients in the previous month, 26.7% (95%CI: 1.3–52.0%) had unprotected sex with non-paying partners in the previous year, 13.3% (95%CI: 0.0–33.0%) had ever injected drugs, 60.0% (95%CI: 23.0–97.0%) reported a past STI and 33.3% (95%CI: 2.0–64.6%) had currently HIV/STI co-infection. The socioeconomic, relational or partnering, and structural contexts conducive to increased risk are warranting further investigation. This knowledge would be valuable to inform prevention programs. HIV interventions, including secondary prevention, should address specific needs of TSW. Outreach initiatives aimed to reach TSW who are difficult to access can play a role in promoting access to health services and reducing HIV infection and transmission.

KEYWORDS:

• Transgender
• sex workers
• risk behaviors
• HIV infection
• health services use

Acknowledgements

The study was partially financed by the ADIS/SIDA Program from the National Program for the Prevention and Control of HIV/AIDS Infection. AG has a PhD Grant from Fundação para a Ciência e a Tecnologia (SFRH/BD/84259/2012). The project team is thankful to FCT for funds to GHTM – UID/Multi/04413/2013. The authors would like to thank the project team members Daniel Simões, Gabriela Cohen, Inês Rego, Ricardo Fernandes, Ricardo Fuertes, Ricardo Rosa and Sara Trindade. The authors are also very grateful to all the community partners of the project. Special thanks to all the participants of this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Fundação para a Ciência e a Tecnologia [grant number SFRH/BD/84259/2012].