title: Sexual behaviors and HIV/syphilis testing among transgender individuals in China: implications for expanding HIV testing services.
abstract: BACKGROUND
  HIV and syphilis are disproportionately common among transgender individuals globally, yet few studies have investigated transgender HIV/syphilis risk and testing in low- and middle-income nations. We conducted an online survey of men who have sex with men (MSM) and transgender individuals to examine sexual behaviors and HIV/syphilis testing in China.
  
  
  METHODS
  We recruited MSM and transgender individuals from 2 major Chinese lesbian, gay, bisexual, and transgender Web platforms. χ Test and logistic regression were used to compare risk behaviors, HIV and syphilis testing history, and prevalence between transgender individuals and other MSM.
  
  
  RESULTS
  Among the 1320 participants, 52 (3.9%) self-identified as transgender. Demographics, including education, employment, and marital status, were similar between both groups, whereas transgender individuals were older. Condomless anal intercourse rate was comparable between the groups. Transgender individuals were less likely to report ever testing for HIV (34.6% vs. 62.0%) and syphilis (15.7% vs. 31.2%) with adjusted odds ratios of 0.36 (95% confidence interval, 0.20-0.65) and 0.42 (95% confidence interval, 0.20-0.91), respectively. We found a trend toward a higher HIV prevalence among transgender individuals (11.1% vs. 5.7%, P = 0.12).
  
  
  CONCLUSIONS
  Transgender individuals have suboptimal HIV and syphilis testing rates in China. Given the substantial risk behaviors and burden of HIV/STI in the general Chinese MSM population and a lack of knowledge about transgender individuals, enhanced HIV/syphilis testing programs for transgender individuals in China are needed.
authors: From the *University of North Carolina Project-China Office, Guangzhou, China; †Department of Medicine, Medical School, University of California-San Francisco, San Francisco, CA; ‡STD Control Department, Guangdong Provincial Center for Skin Diseases and STI Control & Prevention, Guangzhou, China; §Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; and ¶Department of Epidemiology and Biostatistics & Global Health, University of California-San Francisco, San Francisco, CA.
authors: John
authors: J
authors: Best
authors: Weiming
authors: W
authors: Tang
authors: Ye
authors: Y
authors: Zhang
authors: Larry
authors: L
authors: Han
authors: Fengying
authors: F
authors: Liu
authors: Shujie
authors: S
authors: Huang
authors: Bin
authors: B
authors: Yang
authors: Chongyi
authors: C
authors: Wei
authors: Joseph D
authors: JD
authors: Tucker
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D016730:Program Development; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D013587:Syphilis / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data*; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*