title: HIV prevalence and demographic determinants of condomless receptive anal intercourse among trans feminine individuals in Beirut, Lebanon.
abstract: Growing evidence suggests increased HIV incidence in the Middle East and North Africa among "key populations." To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region. Through the lens of the Gender Affirmation Framework, we assessed demographic correlates of risk behaviour and the prevalence of HIV among trans feminine individuals in Lebanon.
  
  
  
  Long-chain referral sampling was used to recruit 53 participants for completion of a behavioural survey and optional free rapid HIV tests. Data were collected using interviewer-administered questionnaires. A multivariable logistic regression model was used to identify demographic determinants of HIV risk behaviour.
  
  
  
  Fifty-seven percent of participants reported condomless receptive anal intercourse (CRAI) with male partner(s) in the last three months, 40% of whom reported not knowing the HIV status of the partner(s). Of the participants tested for HIV as part of the study or via self-report, four (10%) were HIV positive; 13 declined HIV testing. Forty percent of the sample had no prior history of HIV testing. A history of trauma such as sexual abuse/assault was reported by almost half of the participants (49%). Sixty-eight percent reported experiencing physical violence and 32% police arrest, because of gender identity or presentation. A staggering 98% reported having experienced gender identity or gender presentation-related discrimination. Sixty-six percent of the sample reported current sex work; sex work was correlated with CRAI but was not significant in multivariate analysis. In regression analysis, "openness"/"outness" about transgender identity at work or school was significantly associated with CRAI. Surprisingly, a history of sexual abuse/assault was negatively correlated with CRAI, suggesting the need for further inquiry.
  
  
  
  The results of this study provide implications for how to address sexual health among trans feminine individuals in Lebanon and the greater Middle East and North Africa region.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.|Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA; rachel.kaplan@ucsf.edu.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Kaplan
authors.affiliation: Global Health Sciences, University of California, San Francisco, CA, USA.
authors.forename: Justine
authors.initials: J
authors.lastname: McGowan
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D057566:Self Report; D011477:Sex Work; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D063106:Transgender Persons; D055815:Young Adult
keywords: CRAI; HIV prevalence; Lebanon; Middle East and North Africa (MENA); URAI; trans feminine; transgender