Table 1.
Distribution of characteristics of transgender women vs. cis-gender men who have sex with men (MSM), Kenya
| Characteristicsa | Transgender women N = 108 (12.9%) n (%) |
Cis-gender MSM N = 730 (87.5%) n (%) |
P-value‡ |
|---|---|---|---|
| Site | < 0.001 | ||
| Kisumu | 39 (36.1) | 261 (35.5) | |
| Nairobi | 21 (19.4) | 277 (37.8) | |
| Mtwapa | 18 (16.7) | 112 (15.3) | |
| Malindi | 30 (27.8) | 83 (11.4) | |
| Socio-Demographics | |||
| Age group, in years | 0.924 | ||
| 18–20 | 20 (18.5) | 141 (19.4) | |
| 21–23 | 47 (43.5) | 294 (40.4) | |
| 24–26 | 29 (26.9) | 199 (27.4) | |
| 27–29 | 12 (11.1) | 93 (12.8) | |
| Median (IQR) age in years | 23 (21–25) | 23 (21–25) | 0.782 |
| Highest educational attainment | < 0.001 | ||
| Primary 1–8 | 33 (30.6) | 110 (15.1) | |
| Some secondary | 23 (21.3) | 88 (12.1) | |
| Secondary | 32 (29.6) | 355 (48.6) | |
| Some college or more | 20 (18.5) | 177 (24.2) | |
| Employment status | 0.354 | ||
| Unemployed | 40 (37.0) | 293 (40.7) | |
| Self-Employed/casual work | 50 (46.3) | 282 (39.2) | |
| Employed, parttime or full time | 18 (16.7) | 145 (20.1) | |
| Ever married to female | 12 (11.1) | 92 (12.6) | 0.661 |
| Currently living with female wife or female sex partner | 16 (14.8) | 113 (15.5) | 0.854 |
| Currently living with male sex partner | 61 (56.5) | 332 (45.5) | 0.034 |
| Sexual practices (recall period is past 3 months unless otherwise specified) | |||
| Receptive anal intercourse (RAI) with a male partner | 93 (86.1) | 410 (56.6) | < 0.001 |
| Used condom last RAI | 72 (77.4) | 333 (80.4) | 0.512 |
| Median (IQR) number of total male sex partners | 4 (2–7) | 3 (2–6) | 0.005 |
| 0-1b | 6 (5.6) | 115 (15.9) | 0.012 |
| 2 | 24 (22.4) | 150 (20.8) | |
| 3 | 14 (13.1) | 124 (17.2) | |
| 4 or more | 63 (58.9) | 334 (46.2) | |
| Median (IQR) number of paying male sex partners | 2 (1–4) | 1 (0–3) | 0.021 |
| Zero | 25 (23.8) | 209 (29.2) | 0.008 |
| 1–2 | 36 (34.3) | 313 (43.7) | |
| 3 or more | 44 (41.9) | 194 (27.1) | |
| Median (IQR) number of female sex partners | 1 (0–2) | 1 (0–3) | 0.488 |
| Zero | 45 (44.5) | 311 (44.1) | 0.518 |
| 1–2 | 34 (33.7) | 207 (29.4) | |
| 3 or more | 21 (21.8) | 187 (26.5) | |
| Any paying female sex partners | 37 (36.3) | 193 (27.9) | 0.080 |
| Ever in lifetime had sex with a transgender female | 74 (68.5) | 350 (48.0) | < 0.001 |
| Last sex partner was male | 105 (97.2) | 620 (85.1) | 0.001 |
| Used condom at last sex | 76 (72.4) | 485 (78.2) | 0.186 |
| Lubricant used at last sex | 94 (89.5) | 513 (82.9) | 0.087 |
| Paid for sex with cash | 49 (45.8) | 266 (36.5) | 0.065 |
| Engaged in group sex | 28 (25.9) | 134 (18.4) | 0.065 |
| Any interpersonal violence | 27 (25.0) | 154 (21.1) | 0.361 |
| Any childhood abuse | 76 (71.0) | 441 (60.8) | 0.042 |
| Mental health, stigma, and substance use | |||
| PHQ-9, median (IQR) | 5 (1–8) | 3 (1–7) | 0.112 |
| PHQ-9 ≥ 10 (moderate/severe depressive symptoms) | 21 (19.8) | 96 (13.3) | 0.071 |
| Stigma and discrimination score, median (IQR) | 9 (4–15) | 7 (3–12) | 0.015 |
| AUDIT, median (IQR) | 7 (1–12) | 4 (0–10) | 0.066 |
| AUDIT ≥ 8 Hazardous/Harmful alcohol use | 44 (41.5) | 250 (34.9) | 0.183 |
| DAST, median (IQR) | 0 (0–3.75) | 0 (0–4) | 0.588 |
| DAST > 3 (moderate/substantial/severe) | 31 (28.7) | 244 (33.6) | 0.316 |
| Number of elevated scores for mental health (PHQ ≥ 10), AUDIT (≥ 8), DAST (≥ 3), and stigma (highest quartile) | 0.474 | ||
| 0 | 34 (32.7) | 278 (39.8) | |
| 1 | 36 (34.6) | 202 (28.9) | |
| 2 | 18 (17.3) | 127 (18.2) | |
| 3 | 11 (10.6) | 72 (10.3) | |
| 4 | 5 (4.8) | 19 (2.7) | |
| HIV Risk and Prevention | |||
| What are your chances of getting HIV/AIDS | 0.030 | ||
| No chance at all | 31 (28.7) | 309 (42.5) | |
| Small chance | 38 (35.2) | 212 (29.1) | |
| Moderate chance | 14 (13.0) | 95 (13.1) | |
| Great chance | 25 (23.2) | 112 (15.4) | |
| Ever taken PrEP | 0.038 | ||
| Never heard of it | 10 (9.3) | 107 (14.7) | |
| No | 40 (37.0) | 322 (44.2) | |
| Yes | 58 (53.7) | 300 (41.1) | |
| Still taking PrEP (among those ever taken PrEP) | 45 (77.6) | 183 (61.0) | 0.016 |
| Gender Affirming Therapies (GAT) Taken or Currently Using | |||
| Any feminizing GAT | 15 (14.0) | 59 (8.2) | 0.048 |
| Feminizing hormonal agents such as estradiol or progesterone | 12 (11.2) | 32 (4.4) | 0.004 |
| Anti-androgen agents such as aldactone or spironolactone | 3 (2.8) | 21 (2.9) | > 0.999 |
| Silicone breast implants | 2 (1.9) | 12 (1.7) | 0.700 |
aNot all cells sum to N due to missing data
bIncludes n = 19 participants who reported zero male sex partners in the past 3 months. The number of male sex partners is not inclusive of the number of paying male sex partners, as these questions were assessed separately
‡Chi-square test applied for categorical variables; Wilcoxon rank sum test applied for continuous data comparisons, as all had non-normal distribution