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Global Health Econ Sustain Transgenders HIV-related knowledge and risk behaviors

female at birth (AFAB) to denote individuals designated male critical to regularly monitor and update our knowledge
or female at birth, respectively. A transgender individual may of HIV prevalence and burden to identify trends that can
exhibit numerous traits traditionally associated with a specific inform policy-making and interventions for the betterment
gender while identifying elsewhere on the conventional of this marginalized group. Even though both AMAB and
gender continuum or existing beyond it, adopting identities AFAB individuals continue to face a disproportionately
such as other, agender, gender-neutral, genderqueer, non- high HIV burden due to the risk behaviors and insufficient
binary, and third gender. The transgender population has HIV-related knowledge, transgender individuals confront
long been recognized as one of the most vulnerable groups hurdles in accessing and mainstreaming medical treatment,
to human immunodeficiency virus (HIV) transmission and in addition to social and institutional challenges. Thus, this
a prime target for interventions (Reback et al., 2021). In study attempts to discover the transgender community’s
low- and middle-income countries, the pooled prevalence of HIV-related knowledge and risk behaviors.
HIV among AFAB stands at 19.90%, with AMAB prevalence
at 2.56%, while in high-income countries, it reaches 21.60% 2. Methods
(Stutterheim et al., 2021). These findings indicate that both 2.1. Study design, participants, and procedure
AMAB and AFAB, locally known as the “Hijra Community”
in Bangladesh, are approximately 13 times more likely to be From January 2022 to December 2022, a cross-sectional
infected with HIV than the general adult population (Reback face-to-face survey was conducted, involving 135
et al., 2021). Furthermore, AFABs face a myriad of health respondents at a drop-in-center (DIC) (Badhon Hijra
and non-health difficulties, including issues related to poor Songho at Uttar Badda) and three Hijra Pollis (Hijra Pollis
sexual and reproductive health, as well as impediments to at Kamlapur Railway Field Center, Mohakhali Railgate
health-care access stemming from stigma and prejudice Field Center, and Rampura Bridge Field Center). Using
(Khan et al., 2009). a convenient sample technique, both AMAB and AFAB
individuals over the age of 18 who were registered with or
The global surge in HIV incidence and the multitude of beneficiaries of a DIC were considered as sampling units.
challenges confronting AFAB are evident in Bangladesh. A semi-structured questionnaire with an HIV knowledge
The first incidence was identified in 1989, and to date, the questionnaire-18 (HIV-KQ-18) scale, encompassing
country has successfully reduced HIV prevalence among diverse information regarding HIV-related knowledge,
the general population to 0.01% and among transgender was incorporated. To conclude the technique and assess
individuals (a key demographic) to 1%, with a specific rate the efficiency of the research instruments, pre-testing
of 0.90% in Dhaka City (ESCAP & HIV/AIDS, 2016). Both was conducted on 10 respondents at a DIC (Kuril Bisso-
AMAB and AFAB individuals are at risk of HIV infection road, Uttara). However, individuals who were HIV/AIDS
due to a lack of understanding and a negative attitude positive among transgender individuals and other minority
toward HIV and acquired immunodeficiency syndrome groups (lesbian, gay, bisexual, queer, and intersex) or any
(AIDS). However, when evaluating HIV/AIDS education mentally disabled transgender individuals were excluded
initiatives, there is a paucity of research and data on the from this study.
transgender community (Samsul et al., 2016). Despite
requests, comprehensive attempts to address these issues 2.2. Sampling procedure
among AFAB individuals in most parts of the world remain The sample size was calculated based on a 95% confidence
insufficient. High-risk behaviors, such as unprotected anal level (CI), with a permissible error (degree of precision)
intercourse, sexually transmitted infection co-infection, set at 10% (0.10). The decision was influenced by the
and engagement in commercial sex work, have been linked characteristics of the minority group, specifically the
to the high incidence (Shava et al., 2020). In addition, prevalence of accessible HIV testing among transgender
unsafe injection practices are an additional risk factor for individuals in Dhaka City, which was reported as 0.76
HIV transmission in this group in certain circumstances (Khan et al., 2009).
(Siamisang et al., 2022). A comprehensive meta-analysis
study found that the total HIV prevalence among AFAB As a result, the calculated sample size was 70.07.
individuals was 19.9%, whereas it was 2.5% among AMAB However, during the data collecting period, a total of 135
individuals. Significantly, AFAB individuals were 66 times transgender individuals were identified in the DIC and
more likely than individuals over the age of 16 to be HIV Hijra Pollis, and data were collected from all of them.
positive. On the other hand, AFAB individuals were almost
7 times more likely than non-transgender individuals to be 2.3. Socio-demographic and sexual risk behaviors
HIV positive (Stutterheim et al., 2021). Given the dynamic The survey included a mix of closed-ended and open-
nature of HIV risk among transgender individuals, it is ended questions to collect sociodemographic and sexual

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/ghes.1643