The rate of HIV infection among Cambodia’s transgender women is nearly six times higher than the national average, according to the results of a 2012 survey published in the online journal PLOS ONE this month.
Researchers supported by USAID interviewed and tested some 891 transgender women—individuals who were born as males, but identify as women or as a third gender—aged 18 and older, and found an HIV infection rate of 4.15 percent, compared to 0.7 percent for the general population.
Nearly a third of the individuals interviewed as part of the 2012 survey said they had been assaulted in the past six months, and more than half reported experiencing discrimination in their lifetimes. But the study group also showed resilience, with just 15 percent reporting having low self-esteem—a factor researchers identified as being closely linked to a higher risk of HIV infection.
Nita Quan (not her real name), a 29-year-old transgender model and actress, said discrimination was a routine part of her work and social life. She said many well-known nightclubs barred her from entering and that modeling agencies had backed out of shoots when they found out she was transgender.
“That hurts—it really hurts,” she said.
Nuon Sidara, a project coordinator at the Cambodian Center for Human Rights, said he believed that discrimination and infection rates were linked.
“Many transgender women in particular find it very difficult to find formal employment due to their trans identity, and this leads many trans women to go into sex work,” Mr. Sidara said in an email.
“Based on our interaction with many trans sex workers, we have learned that many of their customers insist on not using condoms,” he added.
Inconsistent condom use during anal sex was one of several risk factors the PLOS ONE study identified.
Just 44 percent of those included in the study reported consistent condom use.
HIV rates were highest among older transgender women and those living in Siem Reap City, as well as those who used drugs or were poorly educated, according to the study.
Cambodia’s transgender infection rate is lower than those reported elsewhere: A 2012 study found that 19 percent of transgender women in 15 countries tested positive for HIV, compared to 12 percent in Thailand and 7 percent in Vietnam.
Mr. Sidara credited major foreign aid projects in the 1990s with helping stem the HIV crisis of that decade.
“Sadly, we are now seeing that funding for HIV/AIDS programs is drying up in Cambodia,” he said. “I fear that this could lead to another HIV/AIDS crisis in Cambodia,” he said.