Reducing HIV Risk among Transgender Women in Thailand: A Quasi-Experimental Evaluation of the Sisters Program |
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Authors: | Duangta Pawa Rebecca Firestone Sindh Ratchasi Olivia Dowling Yaowalak Jittakoat Alex Duke Gary Mundy |
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Affiliation: | 1. Strategic Information Department, Population Services International/Thailand, Bangkok, Thailand.; 2. Research and Metrics Department, Population Services International, Washington, D.C., United States of America.; 3. Research and Metrics Department, Population Services International, Bangkok, Thailand.; 4. Program Department, Population Services International/Thailand, Bangkok, Thailand.; Alberta Provincial Laboratory for Public Health/University of Alberta, Canada, |
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Abstract: | Transgender women are particularly at risk of HIV infection, but little evidence exists on effective HIV prevention strategies with this population. We evaluated whether Sisters, a peer-led program for transgender women, could reduce HIV risks in Pattaya, Thailand. The study used time-location sampling to recruit 308 transgender women in Pattaya into a behavioral survey in 2011. Coarsened exact matching was used to create statistically equivalent groups of program participants and non-participants, based on factors influencing likelihood of program participation. Using multivariable logistic regression, we estimated effects of any program participation and participation by delivery channel on: condom use at last sex; consistent condom and condom/water-based lubricant use in the past 3 months with commercial, casual, and regular partners; and receipt of HIV testing in the past 6 months. Program coverage reached 75% of the population. In a matched sub-sample (n = 238), participation in outreach was associated with consistent condom/water-based lubricant use with commercial partners (AOR 3.22, 95% CI 1.64–6.31). Attendance at the Sisters drop-in center was associated with receiving an HIV test (AOR 2.58, 95% CI 1.47–4.52). Dedicated transgender-friendly programs are effective at reducing HIV risks and require expansion to better serve this key population and improve HIV prevention strategies. |
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