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首页> 外文期刊>BMC Infectious Diseases >Prevalence of HIV, syphilis, and assessment of the social and structural determinants of sexual risk behaviour and health service utilisation among MSM and transgender women in Terai highway districts of Nepal: findings based on an integrated biological and behavioural surveillance survey using respondent driven sampling
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Prevalence of HIV, syphilis, and assessment of the social and structural determinants of sexual risk behaviour and health service utilisation among MSM and transgender women in Terai highway districts of Nepal: findings based on an integrated biological and behavioural surveillance survey using respondent driven sampling

机译：艾滋病毒，梅毒的患病率和尼泊尔泰海公路区的MSM和变性妇女的性风险行为和健康服务利用的社会和结构决定因素的评估：研究结果采用受访者驱动抽样的综合生物学和行为监测调查

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Men who have sex with men (MSM) and transgender people are disproportionately affected by HIV and sexually transmitted infections. MSM and transgender people in Nepal experience considerable discrimination and marginalisation, they are subject to abuse from legal authorities and suffer from mental health issues. These social and structural factors can lead to increased sexual risk behaviour, barriers to accessing health care and result in adverse health outcomes. This study aims to assess the prevalence of HIV and syphilis, and how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and transgender women in the Terai highway districts of Nepal. A cross-sectional survey was conducted in June 2016 in eight Terai highway districts of Nepal, recruiting 340 MSM and transgender women through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake. The prevalence of HIV among MSM was 5%, whereas it was 13% in transgender women. The prevalence of active syphilis was 4% in MSM and 11% among transgender women. Among transgender women, 76% were involved in sex work, and 51% had experienced discrimination in one or more settings. In multivariable analysis, having visited an outreach centre was positively associated with condom use in the last sexual encounter among both MSM (AOR: 5.37, 95% CI: 2.42–11.94, p??0.001) and transgender women (AOR: 2.37, 95% CI: 1.12–5.02, p?=?0.025). Moreover, transgender women who reported being open towards family about sexual identity/behaviour were 2.4 more likely to have visited an outreach centre (AOR: 2.40, 95% CI: 1.04–5.57, p?=?0.041). The high prevalence of HIV and syphilis, as well as indicators of marginalisation and discrimination among transgender women, highlights the increased burden transgender women in Nepal are facing and the need for tailored interventions. Moreover, since health care service uptake is an important factor in determining sexual risk behaviour among MSM and transgender women in Nepal, outreach services should be scaled up.
机译：与男人（MSM）和变性人发生性关系的男性因艾滋病毒和性传播感染而不成比例地受到影响。尼泊尔的MSM和跨性别人士体验着歧视和边缘化的相当大，他们受到法律当局的滥用，并遭受心理健康问题。这些社会和结构因素可能导致性风险行为增加，访问医疗保健的障碍，导致不利的健康结果。本研究旨在评估艾滋病毒和梅毒的患病率，以及个人和社会结构因素如何影响尼泊尔泰泰公路区的MSM和跨性别妇女的性风险行为和医疗服务。 2016年6月在尼泊尔的八个泰国公路区进行了横断面调查，通过受访者的驱动抽样招募了340名MSM和跨性别妇女。主要结果变量是艾滋病毒和梅毒患病率。二次结果变量是性风险行为和医疗保健服务。 Logistic回归模型用于评估性风险行为和医疗保健服务的个人和社会结构决定因素。 MSM中艾滋病毒的患病率为5％，而转型妇女则为13％。活性梅毒的患病率为MSM中的4％，转化妇女性中为11％。在变性女性中，76％参与性行为，51％的歧视在一个或多个设置中受到歧视。在多变量分析中，访问过的外展中心与MSM的最后一次性遭遇中的安全套有关（AOR：5.37,95％CI：2.42-11.94，P？<0.001）和变性女性（AOR：2.37， 95％CI：1.12-5.02，p？= 0.025）。此外，报告对家庭开放有关性身份/行为的跨性别妇女是访问过的外展中心（AOR：2.40,95％CI：1.04-5.57，P？= 0.041）。艾滋病毒和梅毒的普及率高，以及变性妇女的边缘化和歧视指标，突出了尼泊尔中的增加的重塑妇女面临，需要量身定制的干预措施。此外，由于医疗保健服务，因此尼泊尔在尼泊尔的MSM和变性妇女中确定性风险行为的重要因素，应扩大外联服务。

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