# Differences in sexual risk behaviours, HIV care utilisation and experiences of stigma between transgender women and cisgender men who have sex with men: findings from integrated biobehavioural surveys in Ukraine 2013–2018

## TL;DR

Transgender women in Ukraine face higher sexual risk behaviors and stigma compared to cisgender men who have sex with men, despite similar HIV rates.

## Contribution

This study provides empirical evidence on the distinct HIV risk profiles and stigma experiences of transgender women compared to cisgender men in Ukraine.

## Key findings

- Transgender women were more likely to engage in commercial sex, group sex, and chemsex compared to cisgender men.
- Transgender women reported significantly higher experiences of stigma, physical assault, and coercive sex.
- HIV prevalence was similar between transgender women and cisgender men, but transgender women faced greater stigma and violence.

## Abstract

To assess whether transgender women who have sex with men (TGWSM) sampled in men who have sex with men (MSM) biobehavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence and engagement in the HIV care than cisgender MSM (CMSM).

Analysis of secondary data from three population-level cross-sectional surveys.

The analysis was conducted on data from three rounds of integrated biobehavioural surveys of MSM in 27 cities of Ukraine from 2013 to 2018.

Data from n=18 621 MSM with n=18 102 CMSM and n=503 TGWSM.

The primary outcomes were differences in sexual risk behaviours, HIV testing and treatment uptake, and the secondary outcomes were differences in lifetime experiences of stigma, coercive sex and physical assault (in the 2018 survey only) between CMSM and TGWSM.

Compared with CMSM, TGWSM were more likely to be clients of non-governmental organisations (adjusted OR, aOR: 1.39, 95% CI 1.15 to 1.67), engage in commercial sex (last month; aOR: 1.28, 95% CI 1.01 to 1.61), have group sex (aOR: 1.31, 95% CI 1.06 to 1.61), more long-term sex partners (last month; adjusted incidence rate ratio: 1.14, 95% CI 1.03 to 1.27), history of imprisonment (aOR: 1.51, 95% CI 1.00 to 2.31) and engage in chemsex (last month, aOR: 1.58, 95% CI 1.12 to 2.23). We found no difference in HIV prevalence (5.17% in TGWSM vs 5.43% in CMSM, p=0.065). In 2018, more TGWSM reported lifetime experience of stigma from family and friends (aOR: 3.58, 95% CI 2.54 to 5.04), general social stigma (aOR: 3.13, 95% CI 2.22 to 4.41), anticipated healthcare stigma (aOR: 3.63, 95% CI 2.53 to 5.16), physical assault (aOR: 2.73, 95% CI 1.85 to 4.03) and coercive sex (aOR: 3.01, 95% CI 1.99 to 4.55) than CMSM.

TGWSM in Ukraine may be at increased risk of HIV acquisition compared to CMSM due to many factors including elevated levels of stigma and violence. Services specifically tailored for transgender people are needed to help reduce these high-risk behaviours.