Geographic and age-group analysis of key Global AIDS Monitoring (GAM) indicators among the transgender women or Hijra populations in Bangladesh: data from IBBS 2020 surveillance

In Bangladesh, research mainly centers on male and female genders, with little focus on Hijra individuals. This study aimed to analyze geographic and age-group variations in key Global AIDS Monitoring (GAM) indicators among the Hijra population. Data were derived from the latest Bangladesh Integrated Biological and Behavioral Surveillance (IBBS) 2020 that included 1172 Hijra individuals stratified by < 25 vs. ≥25 years age group. Key indicators analyzed were HIV prevalence, testing, active syphilis prevalence, condom use, HIV prevention programs coverage, and stigma and discrimination-related healthcare avoidance behavior. The HIV prevalence in the Hijra population was 1%, markedly higher than the overall Bangladeshi population (< 0.01%). Hijra aged ≥ 25 years had a higher HIV prevalence (1.3%) than < 25 years (0.3%, PR = 0.2). Syphilis prevalence was also high (11.9%), particularly in the older group (11.8% vs. 8.6%, PR = 0.7). Younger Hijra (< 25 years) were more engaged in HIV prevention programs (57.8% vs. 49%, PR = 1.2, p = 0.005), HIV testing (46.6% vs. 41.9%, PR = 1.1, p = 0.139), and condom use (42.9% vs. 33.9%, PR = 1.3, p = 0.003). However, stigma-related healthcare avoidance was higher in older Hijra (29.8% vs. 25.3%, PR = 0.8, p = 0.100). There was a strong positive correlation between program coverage and HIV testing (r = 0.850, p = 0.008) and condom use (r = 0.900, p = 0.002). Regionally, HIV prevalence was highest in Rajshahi (2.3%), with active syphilis most prevalent in Chattogram (24.8%). The Hijra population in Bangladesh exhibits significant age and geographic disparities in key GAM indicators. Targeted and age-appropriate interventions, promoting condom use and comprehensive anti-stigma programs are needed to address their unique challenges.