The objectives of this cross-sectional study were to determine the prevalence of Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STI) in Hijras (self-identified transgenders of South Asia), study associated risk factors, and compare the prevalence with that in heterosexual men and men having sex with men (MSM) in Pune, India between 1993 and 2002.
Following informed consent, individuals attending 3 STI clinics were administered a questionnaire regarding their demographic, socioeconomic, and sexual behaviors. Blood samples were collected for STI and HIV diagnosis. Bivariate and multivariate analyses were performed to determine the correlates of HIV infection.
The prevalence of HIV (45.2% in Hijras vs 20% in heterosexual men vs 18.9% in MSM, p < 0.0001) and warts (10.3% vs 4.6% vs 7.0%; p 0.004) was higher in Hijras as compared to heterosexual men and MSM; while that of genital ulcer disease (GUD) (15.3% vs 32.6% vs 21.5%; p <0.0001) and discharge (5.4% vs 13.6% vs 9.0%; p <0.0001) was lower. Hijras were more likely to have received money for sex and have an earlier sexual debut than the comparison groups. In multivariate analysis, receiving money for sex (adjusted odds ratio: 4.49; p< 0.04) and having GUD (OR: 3.87; p<0.08) were independently associated with high HIV prevalence in Hijras.
Considering the high HIV and STI burden, it is important to review current prevention strategies and stress the need to engage Hijra community members through appropriate targeted intervention programs.
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