title: Reducing HIV risk among transgender women in Thailand: a quasi-experimental evaluation of the sisters program.
abstract: Transgender women are particularly at risk of HIV infection, but little evidence exists on effective HIV prevention strategies with this population. We evaluated whether Sisters, a peer-led program for transgender women, could reduce HIV risks in Pattaya, Thailand. The study used time-location sampling to recruit 308 transgender women in Pattaya into a behavioral survey in 2011. Coarsened exact matching was used to create statistically equivalent groups of program participants and non-participants, based on factors influencing likelihood of program participation. Using multivariable logistic regression, we estimated effects of any program participation and participation by delivery channel on: condom use at last sex; consistent condom and condom/water-based lubricant use in the past 3 months with commercial, casual, and regular partners; and receipt of HIV testing in the past 6 months. Program coverage reached 75% of the population. In a matched sub-sample (n = 238), participation in outreach was associated with consistent condom/water-based lubricant use with commercial partners (AOR 3.22, 95% CI 1.64-6.31). Attendance at the Sisters drop-in center was associated with receiving an HIV test (AOR 2.58, 95% CI 1.47-4.52). Dedicated transgender-friendly programs are effective at reducing HIV risks and require expansion to better serve this key population and improve HIV prevention strategies.
authors.affiliation: Strategic Information Department, Population Services International/Thailand, Bangkok, Thailand.
authors.forename: Duangta
authors.initials: D
authors.lastname: Pawa
authors.forename: Rebecca
authors.initials: R
authors.lastname: Firestone
authors.forename: Sindh
authors.initials: S
authors.lastname: Ratchasi
authors.forename: Olivia
authors.initials: O
authors.lastname: Dowling
authors.forename: Yaowalak
authors.initials: Y
authors.lastname: Jittakoat
authors.forename: Alex
authors.initials: A
authors.lastname: Duke
authors.forename: Gary
authors.initials: G
authors.lastname: Mundy
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D015397:Program Evaluation; D012307:Risk Factors; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D012944:Social Support; D013785:Thailand; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult; D008297:Male