Prevalence and correlates of amphetamine-type stimulant use among transgender women in Cambodia

Background: The use of amphetamine-type stimulants (ATS) is associated with increases in HIV infections and other negative health outcomes. Globally, transgender women are among the most vulnerable to HIV. In this paper, we report the prevalence and correlates of ATS use among transgender women in Cambodia. Methods: In 2016, 1375 transgender women were recruited for the National Integrated Biological and Behavioural Survey using respondent-driven sampling method. Participants were recruited from the capital city of Phnom Penh and 12 other provinces. A structured questionnaire was used to collect information on demographic characteristics, sexual behaviours, ATS and other substance use, depressive symptoms, gender-based violence, adverse childhood experiences, stigmatization, and social support. Weighted multivariable logistic regression analyses were conducted to identify risk factors associated with ATS use in the past three months. Results: Overall, the most commonly reported illicit drug used by the survey participants was ATS (10.4%). ATS use was more likely to occur among participants who: (1) were urban dwellers, (2) were 25 to 34 years old, 3) had low levels of education, (4) engaged in transactional sex, (5) inconsistently used condoms with commercial partners, (6) reported binge drinking, (7) had depressive symptoms, (8) had a feeling that co-workers/classmates were not supportive regarding their transgender identity, and (9) had experienced emotional abuse during childhood. Conclusion: ATS were the most commonly reported illicit drugs among transgender women in this study. To mitigate potential negative outcomes, developing and implementing additional harm reduction strategies tailored to ATS use among transgender women is needed. Integration of HIV and mental health interventions into harm reduction programs is required.