Violence and Associated Risk Factors Among Hijra and Transgender Persons in India: Analysis of the Integrated Biological and Behavioral Surveillance Survey

Purpose: This study aimed to determine the prevalence of and factors associated with physical and sexual violence among Hijra and transgender persons in India. Methods: This cross-sectional analysis utilized data from 4964 Hijra and transgender persons across 11 Indian states from the Integrated Biological and Behavioral Surveillance Survey 2014–2015. Data were collected using cluster sampling for fixed locations and time-location sampling for mobile Hijra and transgender persons. Bivariate analysis utilizing binary logistic regression was performed to identify factors linked to each type of violence. We used stepwise logistic regression with a backward elimination approach to identify independent factors associated with physical and sexual violence. We calculated crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) to assess associations between variables. All statistical analyses were carried out using STATA version 16.1. Results: The prevalence of physical and sexual violence among Hijra and transgender persons was 27.2% and 22.3%, respectively. Substance use Hijra and transgender persons who were engaged in high-risk work had higher odds of experiencing physical violence compared with those involved in traditional occupations (aOR 2.00; 95% CI 1.34–2.94, p = 0.001). Hijra and transgender persons who were divorced/widowed/others had higher odds of having experienced sexual violence compared with those who were currently married (aOR 1.78; 95% CI 1.23–2.58, p = 0.002). Conclusion: Factors associated with increased risk of physical and sexual violence against Hijra and transgender persons in India included substance use, involvement in high-risk work, inconsistent condom use, and certain relationship dynamics.