Skip to main content

Advertisement

SpringerLink
Log in

HIV Testing by Gender Identity Among Sexually Active Transgender-, Intersex-, and Hijra Individuals Reached Online in India

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Online outreach may be an important strategy to reach Indian gender minority (GM) populations for HIV testing. However, little is known about Indian GM populations reached online who are sexually active and their HIV testing behaviors. We conducted a secondary analysis of an India wide online cross-sectional survey to assess HIV testing and identify associated factors. The 467 GM respondents identified their gender as transgender women (29.6%), Hijra (5.1%), intersex (37%), or gender non-binary (28.3%). Overall, almost half (47.5%) had never been tested for HIV; among respondents having condomless anal sex, half (50%) reported never testing for HIV. A decreased odds of ever HIV testing was associated with being unsure how to access free testing (compared to being easy; AOR = 0.36, 95%CI 0.20, 0.63) and unaware of comfortable testing sites (AOR = 0.32, 95% CI 0.20, 0.63). Increased odds of testing were associated with identifying as Hijra (compared to transgender women; AOR = 4.07, 95%CI 1.18–16.92) and disclosing sexual behaviors to a doctor (AOR = 3.20, 95% CI 1.91, 5.46). In this GM sample recruited online, HIV testing rates were low. Online interventions are needed to engage individuals with diverse GM identities in India for linkage to accessible and acceptable HIV testing options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article.

Code Availability

N/A.

References

  1. National AIDS Control Organization. Sankalak: status of national AIDS response. 4th ed. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2022.

    Google Scholar 

  2. National AIDS Control Organization. Targeted interventions under NACP-III: operational guidelines, vol. 1. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2007.

    Google Scholar 

  3. National AIDS Control Organization. Strategy document NACP IV (2012–2017). New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2012.

    Google Scholar 

  4. Shaikh S, Mburu G, Arumugam V, Mattipalli N, Aher A, Mehta S, et al. Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India. J Int AIDS Soc. 2016;19(3 Suppl 2):20809. https://doi.org/10.7448/IAS.19.3.20809.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chakrapani V. HIV and STI prevalence, vulnerability and sexual risk among Hijras and other male-to-female transgender people in India: a research synthesis and meta-analysis. New Delhi: United Nations Development Program (UNDP); 2014.

    Google Scholar 

  6. Pandya AK, Redcay A. Access to health services: barriers faced by the transgender population in India. J Gay Lesbian Ment Health. 2021;25(2):132–54.

    Article  Google Scholar 

  7. Ganju D, Saggurti N. Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India. Cult Health Sex. 2017;19(8):903–17.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Beattie TS, Bhattacharjee P, Suresh M, Isac S, Ramesh BM, Moses S. Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India. J Epidemiol Community Health. 2012;66 Suppl 2:ii42–8.

    Article  PubMed  Google Scholar 

  9. Chakrapani V, Babu P, Ebenezer T. Hijras in sex work face discrimination in the Indian health-care system. Res Sex Work. 2004;7:12–4.

    Google Scholar 

  10. Khan MNM, Sarwar G, Irfan SD, Gourab G, Rana AKMM, Khan SI. Understanding the barriers of HIV testing services for men who have sex with men and transgender women in Bangladesh: a qualitative study. Int Q Community Health Educ. 2022;42(3):309–23. https://doi.org/10.1177/0272684X21995672.

    Article  Google Scholar 

  11. Woodford MR, Chakrapani V, Newman PA, Shunmugam M. Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai, India. Glob Public Health. 2016;11(3):363–79.

    Article  PubMed  Google Scholar 

  12. Chakrapani VMS, Buggineni P, Barr F. Sexual and reproductive health of males-at-risk in India: service needs, gaps, and barriers. India: India HIV/AIDS Alliance; 2008. p. 2008.

    Google Scholar 

  13. Wilkerson JM, Patankar P, Rawat SM, Simon Rosser BR, Shukla KM, Rhoton J, et al. Recruitment strategies of Indian men who have sex with men in the state of Maharashtra into an online survey. Int J Sex Health. 2016;28(3):221–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li DH, Rawat S, Rhoton J, Patankar P, Ekstrand ML, Simon Rosser BR, et al. Harassment and violence among men who have sex with men (MSM) and Hijras after reinstatement of India’s “Sodomy Law.” Sex Res Soc Policy. 2017;14(3):324–30.

    Article  Google Scholar 

  15. Patel VV, Rawat S, Dange A, Lelutiu-Weinberger C, Golub SA. an internet-based, peer-delivered messaging intervention for HIV testing and condom use among men who have sex with men in India (CHALO!): pilot randomized comparative trial. JMIR Public Health Surveill. 2020;6(2): e16494.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zlotorzynska M, Sullivan P, Sanchez T. The annual American men’s internet survey of behaviors of men who have sex with men in the United States: 2015 key indicators report. JMIR Public Health Surveill. 2017;3(1):e7119.

    Article  Google Scholar 

  17. Hagell PHP, Meads DM, Nyberg L, McKenna SP. Effects of method of translation of patient-reported health outcome questionnaires: a randomized study of the translation of the Rheumatoid Arthritis Quality of Life (RAQoL) Instrument for Sweden. Value Health. 2010;13(4):424–30.

    Article  PubMed  Google Scholar 

  18. Patel VV, Dange A, Rawat S, Arnsten JH, Pina C, Golub SA, et al. Barriers to HIV testing among men who have sex with men in India reached online: implications for interventions. J Acquir Immune Defic Syndr. 2018;78(4):e30–4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30:377–99.

    Article  PubMed  Google Scholar 

  20. Melendez RM, Pinto RM. HIV prevention and primary care for transgender women in a community-based clinic. J Assoc Nurses AIDS Care. 2009;20(5):387–97.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mwango L, Toeque MG, Lindsay B, Tembo K, Sakala H, Reggee S, et al. Reaching transgender populations in Zambia for HIV prevention and linkage to treatment using community-based service delivery. J Int AIDS Soc. 2022;25 Suppl 5(Suppl 5):e25995.

    PubMed  Google Scholar 

  22. Agoramoorthy G, Hsu MJ. Living on the societal edge: India’s transgender realities. J Relig Health. 2015;54(4):1451–9.

    Article  PubMed  Google Scholar 

  23. Mal S. The Hijras of India: a marginal community with paradox sexual identity. Indian J Soc Psychiatry. 2018;34(1):79.

    Article  Google Scholar 

  24. Radix AE, Bond K, Carneiro PB, Restar A. Transgender individuals and digital health. Curr HIV/AIDS Rep. 2022;19(6):592–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank all the respondents for their time, staff at The Humsafar Trust, Nataly Rios, Christopher Pina, and Dr. Maria Zlotorzynska for their support on this study.

Funding

This research was supported in part by the National Institutes of Health (NIH) Grants R21MH118102 (PI Patel), the Einstein-Rockefeller-CUNY Center for AIDS Research (P30AI124414), Emory University Center for AIDS Research (P30AI050409), and R01MH119001 (PI Patel). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Health System, 3300 Kossuth Avenue, Bronx, NY, 10467, USA

    Debjyoti Datta & Viraj V. Patel

  2. Humsafar Trust, Mumbai, India

    Alpana Dange & Shruta Rawat

  3. Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY, USA

    Ryung Kim

Authors
  1. Debjyoti Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alpana Dange
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shruta Rawat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Viraj V. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VVP, AD, SR—Conception, design and data collection. DD—Initial drafting with critical input and revisions from all authors. VVP, DD, RK—Analyses. All authors contributed to interpretating the results, editing, and approved the final version submitted.

Corresponding author

Correspondence to Viraj V. Patel.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest.

Ethical Approval

Approval from Albert Einstein College of Medicine Institutional Review Board and Humsafar Trust Institutional Review Board.

Consent to Participate

All participants provided informed consent.

Consent for Publication

All authors approve of this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Datta, D., Dange, A., Rawat, S. et al. HIV Testing by Gender Identity Among Sexually Active Transgender-, Intersex-, and Hijra Individuals Reached Online in India. AIDS Behav 27, 3150–3156 (2023). https://doi.org/10.1007/s10461-023-04035-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04035-x

Keywords

Search

Navigation