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.

Aijaz, Saher, Vickerman, Peter, Saliuk, Tetiana, Nicholls, Jane, Gillespie, David ORCID: https://orcid.org/0000-0002-6934-2928, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631 and Stone, Jack 2026. 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. BMJ Open 16 (2) , e104918. 10.1136/bmjopen-2025-104918

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Abstract

ObjectivesTo assess whether transgender women who have sex with men (TGWSM) sampled in men who have sex with men (MSM) biobehavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence and engagement in the HIV care than cisgender MSM (CMSM).DesignAnalysis of secondary data from three population-level cross-sectional surveys.SettingThe analysis was conducted on data from three rounds of integrated biobehavioural surveys of MSM in 27 cities of Ukraine from 2013 to 2018.ParticipantsData from n=18 621 MSM with n=18 102 CMSM and n=503 TGWSM.Primary and secondary outcome measuresThe primary outcomes were differences in sexual risk behaviours, HIV testing and 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.ResultsCompared with CMSM, TGWSM were more likely to be clients of non-governmental organisations (adjusted OR, aOR: 1.39, 95% CI 1.15 to 1.67), engage in commercial sex (last month; aOR: 1.28, 95% CI 1.01 to 1.61), have group sex (aOR: 1.31, 95% CI 1.06 to 1.61), more long-term sex partners (last month; adjusted incidence rate ratio: 1.14, 95% CI 1.03 to 1.27), history of imprisonment (aOR: 1.51, 95% CI 1.00 to 2.31) and engage in chemsex (last month, aOR: 1.58, 95% CI 1.12 to 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 to 5.04), general social stigma (aOR: 3.13, 95% CI 2.22 to 4.41), anticipated healthcare stigma (aOR: 3.63, 95% CI 2.53 to 5.16), physical assault (aOR: 2.73, 95% CI 1.85 to 4.03) and coercive sex (aOR: 3.01, 95% CI 1.99 to 4.55) than CMSM.ConclusionsTGWSM 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.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Additional Information:	License information from Publisher: LICENSE 1: Title: cc by, Type: cc by
Publisher:	BMJ Publishing Group
ISSN:	2044-6055
Date of First Compliant Deposit:	25 February 2026
Date of Acceptance:	14 January 2026
Last Modified:	25 Feb 2026 10:00
URI:	https://orca.cardiff.ac.uk/id/eprint/185259

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