1. Factors Associated with HIV Infection among Transgender Women in Cambodia: Results from a National Integrated Biological and Behavioral Survey
Siyan Yi, MD, MHSc, PhD
Director, KHANA Center for Population
Health Research, Cambodia
Adjunct Ass. Professor, Touro University California, USA
July 25, 2017
11/20/2018

2. Global HIV Epidemic among TG Women
Challenges in HIV programs:
Long been known to be at high risk for HIV acquisition and transmission
Poor access to intervention programs, and not well understood due to their hidden and stigmatized nature
HIV prevalence (2000–2011):
Global: 19.1%
LMIC: 17.7%
High-income countries: 21.6%
(Baral et al., Lancet 2013)

3. Objectives
To explore HIV prevalence and examine risk factors for HIV infection among transgender women in Cambodia

4. Methods Cross-sectional survey: Inclusion criteria
Data collection: Dec 2015 – Feb 2016
Study sites: Phnom Penh and 12 provinces
Sample: 1,375
Sampling method: Respondent driven sampling
Inclusion criteria
Being TG women by definition
Age 18 years old or older
Sexually active (having sex with at least one man in past 12M)
Able and willing to provide written informed consent
Ethical consideration: Approval from NECHR, written informed consent, privacy and confidentiality protection
Data analyses: χ2 test, Fisher’s exact test, ANOVA, multivariate logistic regression

5. Independent Factors Associated with HIV Infection
Variables in the final model
AOR (95% CI)
P-value
Community type
Rural
Reference
Urban
2.7 ( )
0.026
Age groups (in years)
<25
25-34
2.1 ( )
0.012
≥35
2.6 ( )
0.010
Education level
High school or higher (≥7 years)
Primary (0-6 years)
1.7 ( )
0.04
Frequency of express/dressing up as a woman
Not all the time
All the time
2.1 ( )
0.014

6. Independent Factors Associated with HIV Infection
Variables in the final model
AOR (95% CI)
P-value
Ever self-injected hormone No
Reference
Yes
4.4 ( )
0.032
Had cut or sores in the genital area in the past 12 months
3.0 ( )
0.023
Ever used online services developed for TG (e.g. Facebook, website)
1.9 ( )
0.012

7. Conclusions
In Cambodia, TG women remain at an increased HIV risk (5.9%) despite the decline in the general population (0.3%).
Recommendations:
Priorities geared towards older and urban TG women with lower level of formal education and stronger feminine identity
Education on safe hormone injection
Prevention and treatment of STI

8. Acknowledgements Funders: Co-Investigators:
President’s Emergency Fund for AIDS Relief (PEPFAR) through United States Agency for International Development (USAID) in Cambodia
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Co-Investigators:
Srean Chhim, MPH, FHI 360, Cambodia
Chanrith Ngin, PhD, KHANA Center for Population Health Research
Pheak Chhoun, MPH, KHANA Center for Population Health Research
Sovannary Tuot, MA, KHANA Center for Population Health Research
Jean-philippe Dousset, MD, FHI 360, Cambodia
Khuondyla Pal (MHSc), KHANA Center for Population Health Research
Phalkun Mun, MPH, National Center for HIV/AIDS, Dermatology and STD (NCHADS), Cambodia