Knowledge, Attitude and Risky Behavior of Sexually Transmitted Diseases Among Transgender Individuals in Swat, Khyber Pakhtunkhwa, Pakistan
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Abstract
Background: Transgender individuals experience disproportionate vulnerability to sexually transmitted infections (STIs) because of intersecting social stigma, healthcare discrimination, educational exclusion, economic marginalization, and sexual risk exposure. Evidence from culturally conservative regions of Pakistan remains limited, particularly from Khyber Pakhtunkhwa. Objective: To assess STI-related knowledge, healthcare attitudes, and risky sexual practices among transgender individuals in Mingora City, Swat District, Khyber Pakhtunkhwa, Pakistan. Methods: A descriptive cross-sectional study was conducted among 121 transgender individuals aged 18–40 years using snowball sampling. Data were collected through a structured questionnaire covering sociodemographic characteristics, STI knowledge, healthcare attitudes, discrimination, and sexual risk practices. Descriptive statistics, chi-square tests, and Spearman correlation analysis were performed using IBM SPSS Statistics version 26, with p < 0.05 considered statistically significant. Results: Most participants were aged 18–30 years, unmarried, illiterate, urban residents, and engaged in dancing. Awareness that STIs are communicable was high (89.3%), but recognition of oral-sex transmission was low (38.0%). Monthly screening preference was reported by 89.3%, while only 47.9% were willing to discuss STIs with a health consultant. Discrimination was reported by 90.1%. Multiple sexual partners (62.8%), preference for unprotected sex (59.8%), sex with injecting drug users (52.9%), and low post-coital HIV testing preference (28.9%) were common. Age and sexual orientation were significantly associated with selected risk practices. Conclusion: Transgender individuals in Swat showed partial STI knowledge but substantial behavioral and healthcare-access vulnerabilities. Peer-led education, confidential screening, transgender-friendly services, and stigma reduction are urgently needed
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