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Sex Transm Dis. 2015 May;42(5):281-5. doi: 10.1097/OLQ.0000000000000269.

Sexual behaviors and HIV/syphilis testing among transgender individuals in China: implications for expanding HIV testing services.

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From the *University of North Carolina Project-China Office, Guangzhou, China; †Department of Medicine, Medical School, University of California-San Francisco, San Francisco, CA; ‡STD Control Department, Guangdong Provincial Center for Skin Diseases and STI Control & Prevention, Guangzhou, China; §Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; and ¶Department of Epidemiology and Biostatistics & Global Health, University of California-San Francisco, San Francisco, CA.



HIV and syphilis are disproportionately common among transgender individuals globally, yet few studies have investigated transgender HIV/syphilis risk and testing in low- and middle-income nations. We conducted an online survey of men who have sex with men (MSM) and transgender individuals to examine sexual behaviors and HIV/syphilis testing in China.


We recruited MSM and transgender individuals from 2 major Chinese lesbian, gay, bisexual, and transgender Web platforms. χ Test and logistic regression were used to compare risk behaviors, HIV and syphilis testing history, and prevalence between transgender individuals and other MSM.


Among the 1320 participants, 52 (3.9%) self-identified as transgender. Demographics, including education, employment, and marital status, were similar between both groups, whereas transgender individuals were older. Condomless anal intercourse rate was comparable between the groups. Transgender individuals were less likely to report ever testing for HIV (34.6% vs. 62.0%) and syphilis (15.7% vs. 31.2%) with adjusted odds ratios of 0.36 (95% confidence interval, 0.20-0.65) and 0.42 (95% confidence interval, 0.20-0.91), respectively. We found a trend toward a higher HIV prevalence among transgender individuals (11.1% vs. 5.7%, P = 0.12).


Transgender individuals have suboptimal HIV and syphilis testing rates in China. Given the substantial risk behaviors and burden of HIV/STI in the general Chinese MSM population and a lack of knowledge about transgender individuals, enhanced HIV/syphilis testing programs for transgender individuals in China are needed.

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