An Exploration of Social Exclusion and Risky Sexual Behaviors Amongst Transgender Women in Karachi, Pakistan Público

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Palabra Clave	LGBT hijra transgender women risky sexual behaviors pakistan social exclusion HIV/AIDS
Committee Chair / Thesis Advisor	Lang, Delia L, Emory University
Committee Members	Nehl, Eric J., Emory University

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