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Transgender sexual health in China: a cross-sectional online survey in China
  1. Ye Zhang1,2,
  2. John Best3,
  3. Weiming Tang1,2,4,
  4. Lai Sze Tso2,
  5. Fengying Liu1,
  6. Shujie Huang1,
  7. Heping Zheng1,
  8. Bin Yang1,
  9. Chongyi Wei5,
  10. Joseph D Tucker2,3
  1. 1Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, China
  2. 2Institute of Global Health and Infectious Diseases, University of North Carolina Project-China, Guangzhou, China
  3. 3School of Medicine, University of California, San Francisco, California, USA
  4. 4University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  5. 5Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, California, USA
  1. Correspondence to Dr Joseph D Tucker, University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou 510095, China; jdtucker{at}


Objective Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China.

Methods We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM.

Results Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to ‘out’, forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months.

Conclusions Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals' experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research.


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  • YZ and JB contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors YZ and JB wrote the main manuscript text; FL, WT and JB analysed the data; YZ and LST collected the data; JDT, BY, HZ, SH and CW oversaw the whole study process. All authors reviewed the manuscript.

  • Funding This study was supported by the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01) and the UJMT Fogarty Fellowship (5R25TW009340, R25TW0093).

  • Competing interests None declared.

  • Ethics approval This study was approved by the ethics review committees in China (Guangdong Provincial Center for Skin Diseases and STI Control, IRB board approval number: 5100477) and USA (University of North Carolina at Chapel Hill and the University of California, San Francisco, IRB board approval number:14-1865).

  • Provenance and peer review Not commissioned; externally peer reviewed.