A Cross-sectional Study of Sexual Practices, Sexually Transmitted Infections and Human Immunodeficiency Virus among Male-to-Female Transgender People

Problem statement: Designing HIV interventions requires evidence on links between behaviors and elevated transmission risk that remains scanty for male-to-female Transgender (TG) people in India. Approach: In 2007, we carried out a cross-sectional study through convenience sampling of 131 TG aged > 18years, residing in Chennai at least prior to six months of the study. Sexual practices and perception towards STIs and HIV were identified through structured interviews. HIV and STIs were diagnosed from blood and urine samples. Associations among sexual practices, HIV/STI and alcohol use were analyzed using contingency tables. Results: The study participants had a mean age of sexual debut of 12.86 years. From the sample, 91% reported involvement with casual, paid and/or long-term sex partners at the time of the study and reported having anal sex in similar proportions across all three types of partners. More individuals failed to use condoms with long-term partners (44%) than with casual (17%) or paid (9%) partners. Alcohol use was more strongly associated with multiple casual and paid partners than with exclusive long-term partners (p<0.05). About 29% reported sex under the influence of alcohol. 72% were diagnosed with least one STI, with viral STIs ranging from 8-48 and 18% diagnosed with HIV. HIV-positive individuals could not be statistically distinguished from HIV-negative individuals on the basis of anal and oral sex, presence/absence of STI, inconsistent condom use or sex under the influence of alcohol. Conclusion/Recommendations: Given the extensive literature on associations between inconsistent condom use, unprotected anal sex, alcohol and HIV risk, the lack of difference between HIV-positive and negative individuals with respect to behaviors suggests that the entire sample represents a group needing primary or secondary prevention intervention. Partner reduction, consistent condom usage and sex under the influence of alcohol are areas for further research and program interventions among TG in Chennai, India.