Differences in sexual risk behaviours, HIV care utilisation, and experiences of stigma between transgender women and cisgender men who have sex with men:findings from Integrated Biobehavioural Surveys in Ukraine 2013 – 2018

<b>Objectives</b>: <br/>To assess whether transgender women who have sex with men (TGWSM) sampled in MSM bio-behavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence, and engagement in the HIV care than cisgender men who have sex with men (CMSM).<br/><br/><b>Design</b>: <br/>Analysis of secondary data from three population-level cross-sectional surveys.<br/><br/><b>Setting</b>: <br/>The analysis was conducted on data from three rounds of Integrated biobehavioural surveys (IBBS) of men who have sex with men in 27 cities of Ukraine from 2013 – 2018.<br/><br/><b>Participants</b>: <br/>Data from n=18,621 men who have sex with men with n=18,102 CMSM and n=503 TGWSM.<br/><br/><b>Primary and secondary outcome measures</b>: <br/>The primary outcomes were differences in sexual risk behaviours, HIV testing, and HIV treatment uptake, and the secondary outcomes were differences in lifetime experiences of stigma, coercive sex, and physical assault (in the 2018 survey only) between CMSM and TGWSM.<br/><br/><b>Results</b>: <br/>Compared to CMSM, TGWSM were more likely to be clients of non-governmental organizations (aOR: 1.39, 95%CI: 1.15-1.67), engage in commercial sex (last month; aOR: 1.28, 95%CI: 1.01-1.61), have group sex (aOR: 1.31, 95%CI: 1.06-1.61), more long-term sex partners (last month; aIRR: 1.14, 95%CI: 1.03–1.27), history of imprisonment (aOR: 1.51, 95%CI: 1.00-2.31), and engage in chemsex (last month, aOR: 1.58, 95%CI: 1.12-2.23). We found no difference in HIV prevalence (5.17% in TGWSM vs 5.43% in CMSM, p=0.065). In 2018, more TGWSM reported lifetime experience of stigma from family and friends (aOR: 3.58, 95%CI: 2.54-5.04), general social stigma (aOR: 3.13, 95%CI: 2.22-4.41), anticipated healthcare stigma (aOR: 3.63, 95%CI: 2.53-5.16), physical assault (aOR: 2.73, 95%CI: 1.85- 4.03) and coercive sex (aOR: 3.01, 95%CI: 1.99-4.55) than CMSM.<br/><br/><b>Conclusions</b>: <br/>TGWSM in Ukraine may be at increased risk of HIV acquisition compared to CMSM due to many factors including elevated levels of stigma and violence. Services specifically tailored for transgender people are needed to help reduce these high-risk behaviours.