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Sociodemographic characteristics and HIV risk behaviors of native-born and displaced Syrian men and transgender women who have sex with men in Lebanon

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Abstract

HIV rates among men and transgender women who have sex with men (MTWSM) in Lebanon are consistent with a concentrated epidemic. Geopolitical and social circumstances leave these communities vulnerable to HIV spread. To document this risk encountered by Lebanese native and displaced Syrian MTWSM, participants, recruited by respondent driven sampling beginning with Syrian seeds, completed a survey with questions covering sociodemographic, behavioral, medical, and stigma, followed by opt-out HIV testing. Analyses included descriptive statistics and linear regression to differentiate between native Lebanese and Syrians who migrated after the onset of the civil war to identify correlations among sociodemographic factors, stigma, and risk behavior as a function of country of birth. Experienced and internalized stigmas were higher in the Syrian born MTWSM and correlated with elements of HIV risk. Combatting the intersectional stigmas of Syrian MTWSM in Lebanon would be most beneficial in mitigating HIV risk for these individuals.

Resumen

Las tasas de VIH entre hombres y mujeres transgénero que tienen sexo con hombres (HMTSH) en el Líbano son consistentes con una epidemia concentrada. Las circunstancias geopolíticas y sociales dejan a estas comunidades vulnerables a la propagación del VIH. Para documentar este riesgo al que se enfrentan los HMTSH nativos libaneses y HMTSH sirios desplazados, los participantes, reclutados mediante un muestreo impulsado por los encuestados que comenzó con semillas sirias, completaron una encuesta con preguntas que cubrían aspectos sociodemográficos, conductuales, médicos y de estigma, seguidas de una prueba de VIH de exclusión voluntaria. Los análisis incluyeron estadísticas descriptivas y regresión lineal para diferenciar entre libaneses nativos y sirios que emigraron después del inicio de la guerra civil para identificar correlaciones entre factores sociodemográficos, estigma y comportamiento de riesgo como función del país de nacimiento. Los estigmas experimentados e internalizados fueron más altos en los HMTSH nacidos en Siria y se correlacionaron con elementos de riesgo de VIH. Combatir los estigmas interseccionales de los HMTSH sirios en el Líbano sería lo más beneficioso para mitigar el riesgo de VIH para estos individuos.

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Acknowledgements

The authors would like the thank the following organizations that serve the LGBTQ community in Lebanon and their staff who served as trained interviewers to help enroll and interview participants in this study: MARSA, Mosaic, “Oui pour la Vie”, SIDC, and HELEM, all of which do exceptional work in difficult circumstances. We would also like to than Georges Azzi and the Arab Foundation for Freedoms and Equality, which served as an umbrella organization that arranged for the remuneration of the individuals who enrolled in this study.

Funding

This work was supported by NIH/NICHD 1R21HD089820-01A1, “Addressing Disparities in HIV Testing and Care among Displaced MSM” and NIH/NICHD grant 1DP2HD091799-01.

Author information

Authors and Affiliations

  1. Immigration Policy Lab, Stanford University, Stanford, CA, United States

    Lilla V. Orr

  2. Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States

    Forrest W. Crawford

  3. Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, 06520-8034, New Haven, CT, USA

    Kaveh Khoshnood & Robert Heimer

  4. Department of Epidemiology & Population Health, American University of Beirut (AUB), Beirut, Lebanon

    Danielle Khouri & Fouad M. Fouad

  5. Global Community Health and Behavioral Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States

    David W. Seal

Authors
  1. Lilla V. Orr
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  4. Danielle Khouri
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  7. Robert Heimer
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Contributions

LO took the lead in conducting the statistical analyses and in drafting parts of the manuscript.

FWC was involved with the design of the study and assisted LO with the statistical analysis.

KK was involved with the design of the study and the contents of the questionnaire, participated in training the field staff in participant recruitment, data collection, and human subjects protections.

DK supervised the field staff, served as the liaison to the local NGOs where many of the interviews were conducted, and was responsible for maintaining and transferring the database.

FMF was involved with the design of the study, the contents of the questionnaire, and led the created of the data collection system.

DWS was involved with the design of the study and the contents of the questionnaire, participated in training the field staff in participant recruitment and data collection.

RH took the lead in designing the study and the contents of the questionnaire, participated in training the field staff in participant recruitment and data collection, and drafted significant sections of the manuscript.

All authors reviewed the drafts of the manuscript, supplied comments and edits, and approved the final manuscript prior to submission.

Corresponding author

Correspondence to Robert Heimer.

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Declarations

The authors have no conflicts of interest to report.

The study was approved by Institutional Review Boards at Yale University and the American University of Beirut. Written consent was obtained.

Full dataset is available upon request.

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Orr, L.V., Crawford, F.W., Khoshnood, K. et al. Sociodemographic characteristics and HIV risk behaviors of native-born and displaced Syrian men and transgender women who have sex with men in Lebanon. AIDS Behav 26, 4004–4011 (2022). https://doi.org/10.1007/s10461-022-03726-1

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