An Exploration of Social Exclusion and Risky Sexual Behaviors Amongst Transgender Women in Karachi, Pakistan Open Access
Hussain, Sharmeen (2016)
Abstract
Background: There is a high prevalence of social exclusion and risky sexual behaviors amongst transgender women in Pakistan. It has been found that sex work is a common career path for this population. Further, this population has shown to have a higher prevalence of HIV than other high-risk populations, such as male and female sex workers. This study aims to describe transgender women in Pakistan based on social exclusion and involvement in risky sexual behaviors. Additionally, it aims to examine whether social exclusion factors are associated with adoption of risky sexual behaviors.
Methods: Researchers utilized a cross-sectional study design to survey a sample of 82 transgender women in Karachi, Pakistan. All surveys were verbally administered by an interviewer, and questionnaires consisted of the following sections: demographics, perceived attitudes, past experiences, access to resources and support, risky sexual behaviors, HIV/AIDS, and STIs. Analysis included calculating descriptive statistics for all items on the survey, Spearman's Rho correlations, and logistic regression models, linear regression models, and chi-square tests of association to test for associations between predictor and outcome variables.
Results: All study participants reported ever-involvement in sex work, with 90.24% reporting current involvement. Number of sex partners over the past 90 days ranged from 1-895. A large majority of participants stated that others found being transgender to go outside Islamic principles, and that they had felt excluded because of their gender identification. Most participants faced physical abuse (79.27%), sexual harassment (96.34%), and sexual violence (75.61%). Seeking medical attention and social support was not a problem for most, whereas finding employment and pursuing an education was. The overall linear regression model with condom use each time was significant, and showed a significant association with past experiences (p=0.03). Chi-square tests showed the highest number of associations between past experiences items and risky sexual behaviors.
Conclusions: This study adds to the current literature regarding social exclusion and risky sexual behaviors amongst transgender women. Although this study did not find sufficient evidence to show an association between social exclusion and risky sexual behaviors, this is an association that should be further explored in the future.
Table of Contents
INTRODUCTION 1
SIGNIFICANCE OF THE STUDY 2
THEORETICAL FRAMEWORK 4
PURPOSE OF CURRENT STUDY 4
REVIEW OF THE LITERATURE 5
TRANSGENDER WOMEN AND HIV/AIDS BURDEN 5
TRANSGENDER WOMEN AND RISKY SEXUAL BEHAVIORS 6
TRANSGENDER WOMEN AND SOCIAL EXCLUSION 8
PURPOSE OF CURRENT STUDY 13
DATA COLLECTION AND ANALYSIS METHODS 14
STUDY SETTING 14
STUDY SAMPLE 14
STUDY DESIGN 15
SURVEY DEVELOPMENT AND PREVIOUS SCALES 15
CURRENT SURVEY AND MEASURES 16
DATA COLLECTION 19
ANALYSIS 20
RESULTS 24
SAMPLE DEMOGRAPHICS 24
PERCEIVED ATTITUDES 25
PAST EXPERIENCES 26
ACCESS TO RESOURCES AND SUPPORT 26
RISKY SEXUAL BEHAVIORS 27
HIV/AIDS 28
STIS 28
CORRELATIONS (DEMOGRAPHICS AND OUTCOME VARIABLES) 28
CORRELATIONS (PREDICTOR VARIABLES, OUTCOME VARIABLES, AND DEMOGRAPHICS) 29
MULTIVARIATE LOGISTIC REGRESSION 29
MULTIVARIATE LINEAR REGRESSION 30
CHI-SQUARED TESTS 30
DISCUSSION 32
DESCRIPTIVE STATISTICS 32
PREDICTIVE MODELS 37
EXPLORATORY FINDINGS 37
STRENGTHS AND LIMITATIONS 38
IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY 41
CONCLUSIONS 44
REFERENCES 75
APPENDICES 77
APPENDIX A. SURVEY INSTRUMENT 77
APPENDIX B. INFORMED CONSENT 84
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