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

Abstract

Background: 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. Methods: 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. Results: 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%). Conclusion: 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.