Contextual Factors that Contribute to Increased Risk of HIV Among Transgender and MSM Sex Workers and Recommendations for Service Delivery Public Deposited

Downloadable Content

Download PDF
Last Modified
  • March 21, 2019
  • Miller, William Meihack
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Globally, male-to-female transgender women and men who have sex with men (MSM) are at increased risk of HIV infection compared to the general population. Despite effective interventions to prevent HIV infection, the incidence among these populations continues to rise. The purpose of this dissertation was to 1) describe the MSM and transgender women missed through venue-based sampling and illustrate how data on venues frequented by MSM and transgender women can be used to prioritize delivery of HIV prevention services; 2) identify contextual factors that contribute to HIV risk among transgender sex workers in Guatemala City. We recruited 1077 unique MSM and transgender women into two cross-sectional behavioral surveys using respondent-driven sampling (RDS) and time-location sampling (TLS) in Guatemala City. To compare the populations reached through RDS vs. venues, the outcomes included the number of partners, sex work, concurrent partners and sex with women. Additionally, access to HIV testing, free condoms, lubricant and IEC activities was analyzed. Contextual outcomes included discrimination, physical abuse, forced sex, rejection by family, drug and alcohol use and were measured through the behavioral questionnaire. Gender identity and sex work were combined to form the exposure. RDS participants who did not frequent venues were older, had lower level of education, were more likely to identify as bisexual or heterosexual, have concurrent partners and sex with women compared to participants from venues. The overwhelming majority of transgender women had received money for sex in the past year. Transgender sex workers were three times as likely to be discriminated against, seven times as likely to be physically abused and eight times as likely to be forced to have sex compared to MSM who did not sell sex. Binge drinking and illicit drug use were more common among transgender sex workers than among non-sex workers. Transgender women in Guatemala and many other countries are affected by adverse life events that act as underlying determinants of HIV infection. Venues where transgender women and MSM can be reached are low-hanging fruit for HIV prevention programs and services should be offered following global guidance for key populations at increased risk.
Date of publication
Resource type
Rights statement
  • In Copyright
  • Miller, William
  • Barrington, Clare
  • Weir, Sharon
  • Emch, Michael
  • Pettifor, Audrey
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016

This work has no parents.