title: Transgender sexual health in China: a cross-sectional online survey in China.
abstract: OBJECTIVE
  Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China.
  
  
  METHODS
  We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM.
  
  
  RESULTS
  Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to 'out', forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months.
  
  
  CONCLUSIONS
  Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals' experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research.
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.|Institute of Global Health and Infectious Diseases, University of North Carolina Project-China, Guangzhou, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: School of Medicine, University of California, San Francisco, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Best
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.|Institute of Global Health and Infectious Diseases, University of North Carolina Project-China, Guangzhou, China.|University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
authors.affiliation: Institute of Global Health and Infectious Diseases, University of North Carolina Project-China, Guangzhou, China.
authors.forename: Lai Sze
authors.initials: LS
authors.lastname: Tso
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Fengying
authors.initials: F
authors.lastname: Liu
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Shujie
authors.initials: S
authors.lastname: Huang
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Heping
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, California, USA.
authors.forename: Chongyi
authors.initials: C
authors.lastname: Wei
authors.affiliation: Institute of Global Health and Infectious Diseases, University of North Carolina Project-China, Guangzhou, China.|School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
keywords: BEHAVIOURAL SCIENCE; CHINA; TRANSSEXUAL