Determinants of multiple sexual partnerships among Hijra and transgender persons in India: evidence from the IBBS survey.

Multiple sexual partnerships (MSPs) act as a risk factor, increase vulnerability to sexually transmitted diseases, including HIV, and contribute to interconnected sexual networks that may facilitate broader transmission not only within high-risk networks but also to their partners. This study aims to estimate the prevalence of MSPs and factors associated with it among Hijra and transgender persons (H/TG) in India. This is a secondary data analysis of H/TG data from the National IBBS survey. The survey was conducted in 14 domains across 11 states of India using probability-based sampling. A total of 4345H/TG individuals were analyzed. Out of these, 3774 (86.9%) reported MSPs. Factors such as living with partners (aOR: 1.86; 95% CI: 1.32, 2.62), having first sexual intercourse before the age of 18 years (aOR: 1.44; 95% CI: 1.14, 1.82), involvement in sex work (aOR: 1.69; 95% CI: 1.27, 2.26), and having a commercial partner (aOR: 11.77; 95% CI: 4.80, 28.86) were associated with MSPs among H/TG persons. The findings of this study demonstrate that MSPs are highly prevalent among H/TG persons in India. Interventions aimed at HIV and STI prevention should move beyond individual-level behavior change approaches and incorporate network-based strategies and early sexual health education.