Prevalence of HIV, syphilis, and assessment of the social and structural determinants of sexual risk behaviour and health service utilisation among MSM and transgender women in Terai highway districts of Nepal: findings based on an integrated biological and behavioural surveillance survey using respondent driven sampling
| Autor: | Bir Rawal, Keshab Deuba, José J Damas, Rajan Bhattarai, Upendra Thapa Shrestha, Margrethe Storm, Gaetano Marrone |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
HIV Infections Health care service uptake Men who have sex with men law.invention 0302 clinical medicine law Risk Factors Surveys and Questionnaires Health care Prevalence 030212 general & internal medicine Middle Aged Infectious Diseases Respondent Female 0305 other medical science Research Article Adult Structural factors Adolescent Sexual Behavior Transgender Persons lcsh:Infectious and parasitic diseases 03 medical and health sciences Young Adult Condom Nepal Environmental health medicine Humans Sexual risk behaviour lcsh:RC109-216 Syphilis MSM Transgender women Homosexuality Male Sex work Sexual identity 030505 public health business.industry HIV Patient Acceptance of Health Care medicine.disease Mental health Sex Work Cross-Sectional Studies Logistic Models STI business |
| Zdroj: | BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-14 (2020) BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background Men who have sex with men (MSM) and transgender people are disproportionately affected by HIV and sexually transmitted infections. MSM and transgender people in Nepal experience considerable discrimination and marginalisation, they are subject to abuse from legal authorities and suffer from mental health issues. These social and structural factors can lead to increased sexual risk behaviour, barriers to accessing health care and result in adverse health outcomes. This study aims to assess the prevalence of HIV and syphilis, and how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and transgender women in the Terai highway districts of Nepal. Methods A cross-sectional survey was conducted in June 2016 in eight Terai highway districts of Nepal, recruiting 340 MSM and transgender women through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake. Results The prevalence of HIV among MSM was 5%, whereas it was 13% in transgender women. The prevalence of active syphilis was 4% in MSM and 11% among transgender women. Among transgender women, 76% were involved in sex work, and 51% had experienced discrimination in one or more settings. In multivariable analysis, having visited an outreach centre was positively associated with condom use in the last sexual encounter among both MSM (AOR: 5.37, 95% CI: 2.42–11.94, p p = 0.025). Moreover, transgender women who reported being open towards family about sexual identity/behaviour were 2.4 more likely to have visited an outreach centre (AOR: 2.40, 95% CI: 1.04–5.57, p = 0.041). Conclusions The high prevalence of HIV and syphilis, as well as indicators of marginalisation and discrimination among transgender women, highlights the increased burden transgender women in Nepal are facing and the need for tailored interventions. Moreover, since health care service uptake is an important factor in determining sexual risk behaviour among MSM and transgender women in Nepal, outreach services should be scaled up. |
| Databáze: | OpenAIRE |
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