Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men
Abstract Background Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analys...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-16348-6 |
| _version_ | 1827632847269134336 |
|---|---|
| author | Supriya D. Mehta Fredrick O. Otieno Joshua Kimani Elizabeth Wahome Duncan Okal Abhishikta Roy Elise van der Elst Susan M. Graham Eduard J. Sanders Robert C. Bailey |
| author_facet | Supriya D. Mehta Fredrick O. Otieno Joshua Kimani Elizabeth Wahome Duncan Okal Abhishikta Roy Elise van der Elst Susan M. Graham Eduard J. Sanders Robert C. Bailey |
| author_sort | Supriya D. Mehta |
| collection | DOAJ |
| description | Abstract Background Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya. Methods We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18–29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma. Results From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 – 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 – 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 – 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 – 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 – 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM. Conclusions Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa. |
| first_indexed | 2024-03-09T14:51:18Z |
| format | Article |
| id | doaj.art-6bf4a086e38c4d32b961b8a764e7e741 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-09T14:51:18Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-6bf4a086e38c4d32b961b8a764e7e7412023-11-26T14:26:51ZengBMCBMC Public Health1471-24582023-08-0123111110.1186/s12889-023-16348-6Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with menSupriya D. Mehta0Fredrick O. Otieno1Joshua Kimani2Elizabeth Wahome3Duncan Okal4Abhishikta Roy5Elise van der Elst6Susan M. Graham7Eduard J. Sanders8Robert C. Bailey9Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public HealthNyanza Reproductive Health SocietyPartners for Health and Development in AfricaKenya Medical Research Institute-Wellcome Trust Research ProgrammeNyanza Reproductive Health SocietyDivision of Epidemiology & Biostatistics, University of Illinois Chicago School of Public HealthGlobal Health Department, University of AmsterdamDepartments of Global Health, Medicine, and Epidemiology, University of Washington, School of MedicineKenya Medical Research Institute-Wellcome Trust Research ProgrammeDivision of Epidemiology & Biostatistics, University of Illinois Chicago School of Public HealthAbstract Background Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya. Methods We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18–29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma. Results From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 – 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 – 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 – 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 – 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 – 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM. Conclusions Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa.https://doi.org/10.1186/s12889-023-16348-6Transgender womenMen who have sex with menStigmaDepressive symptomsSubstance useAlcohol use |
| spellingShingle | Supriya D. Mehta Fredrick O. Otieno Joshua Kimani Elizabeth Wahome Duncan Okal Abhishikta Roy Elise van der Elst Susan M. Graham Eduard J. Sanders Robert C. Bailey Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men BMC Public Health Transgender women Men who have sex with men Stigma Depressive symptoms Substance use Alcohol use |
| title | Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men |
| title_full | Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men |
| title_fullStr | Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men |
| title_full_unstemmed | Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men |
| title_short | Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men |
| title_sort | transgender women in kenya experience greater stigma depressive symptoms alcohol and drug use and risky sexual practices than cis gendered men who have sex with men |
| topic | Transgender women Men who have sex with men Stigma Depressive symptoms Substance use Alcohol use |
| url | https://doi.org/10.1186/s12889-023-16348-6 |
| work_keys_str_mv | AT supriyadmehta transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT fredrickootieno transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT joshuakimani transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT elizabethwahome transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT duncanokal transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT abhishiktaroy transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT elisevanderelst transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT susanmgraham transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT eduardjsanders transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen AT robertcbailey transgenderwomeninkenyaexperiencegreaterstigmadepressivesymptomsalcoholanddruguseandriskysexualpracticesthancisgenderedmenwhohavesexwithmen |