title: HIV Prevalence and Risks Associated with HIV Infection among Transgender Individuals in Cambodia.
abstract: BACKGROUND
  Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia.
  
  
  METHODS
  Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited.
  
  
  RESULTS
  The majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20-27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35-44 and adjusted OR = 7.63 [2.55, 22.81] for age 30-34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37, 23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09, 7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR = 3.25 [1.35, 7.85]) were independently associated with HIV infection.
  
  
  CONCLUSIONS
  This study confirms transgender individuals as one of the highest-risk groups for HIV infection in Cambodia. It suggests the need for programmatic strategies that mitigate identified associated risks and facilitate access to HIV care for this population.
authors.affiliation: FHI 360, Phnom Penh, Cambodia.
authors.forename: Amy
authors.identifier: http://orcid.org/0000-0003-2510-3500
authors.initials: A
authors.lastname: Weissman
authors.affiliation: FHI 360, Phnom Penh, Cambodia.
authors.forename: Song
authors.initials: S
authors.lastname: Ngak
authors.affiliation: FHI 360, Phnom Penh, Cambodia.
authors.forename: Chhim
authors.initials: C
authors.lastname: Srean
authors.affiliation: National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, (NCHADS) and University of Health Science, Phnom Penh, Cambodia.
authors.forename: Neth
authors.initials: N
authors.lastname: Sansothy
authors.affiliation: FHI 360, Bangkok, Thailand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mills
authors.affiliation: FHI 360, Phnom Penh, Cambodia.
authors.forename: Laurent
authors.initials: L
authors.lastname: Ferradini
mesh_terms: D000328:Adult; D002160:Cambodia / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D063106:Transgender Persons / Q000706:statistics & numerical data*