title: Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India.
abstract: BACKGROUND
  The objectives of this cross-sectional study were to determine the prevalence of HIV and sexually transmitted infections (STI) in Hijras (self-identified transgenders of South Asia), study associated risk factors, and compare the prevalence with that in heterosexual men and men having sex with men (MSM) in Pune, India, between 1993 and 2002.
  
  
  METHODS
  After informed consent, individuals attending 3 STI clinics were administered a questionnaire regarding their demographic, socioeconomic, and sexual behaviors. Blood samples were collected for STI and HIV diagnosis. Bivariate and multivariate analyses were performed to determine the correlates of HIV infection.
  
  
  RESULTS
  The prevalence of HIV (45.2% in Hijras vs 20% in heterosexual men vs 18.9% in MSM, P < 0.0001) and warts (10.3% vs 4.6% vs 7.0%; P = 0.004) was higher in Hijras as compared with heterosexual men and MSM; whereas that of genital ulcer disease (15.3% vs 32.6% vs 21.5%; P < 0.0001) and discharge (5.4% vs 13.6% vs 9.0%; P < 0.0001) was lower. Hijras were more likely to have received money for sex and have an earlier sexual debut than the comparison groups. In multivariate analysis, receiving money for sex (adjusted odds ratio: 4.49; P < 0.04) and having genital ulcer disease (odds ratio: 3.87; P < 0.08) were independently associated with high HIV prevalence in Hijras.
  
  
  CONCLUSIONS
  Considering the high HIV and STI burden, it is important to review current prevention strategies and stress the need to engage Hijra community members through appropriate targeted intervention programs.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sushants@ivi.int
authors.forename: Sushant
authors.initials: S
authors.lastname: Sahastrabuddhe
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stuart
authors.forename: Sheela
authors.initials: S
authors.lastname: Godbole
authors.forename: Manisha
authors.initials: M
authors.lastname: Ghate
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.forename: Raman
authors.initials: R
authors.lastname: Gangakhedkar
authors.forename: Arun
authors.initials: A
authors.lastname: Risbud
authors.forename: Anand
authors.initials: A
authors.lastname: Divekar
authors.forename: Robert
authors.initials: R
authors.lastname: Bollinger
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mehendale
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000635:transmission*; D011795:Surveys and Questionnaires; D014189:Transsexualism; D055815:Young Adult