Transgender women in Cambodia are at particular risk of being infected with HIV, and the prevalence of the disease within that population is on the rise, a new study has found.

The study, published in BMC International Health and Human Rights last week, finds that out of 1,375 adult transgender women surveyed across 12 provinces and Phnom Penh, 5.9 percent were HIV-positive. This compares with 0.6 to 0.7 percent in the general population.

The authors do not analyse correlation between different factors but note that “more than one-third (39.1%) reported not using condoms in their last” sexual encounter, and that “a significant number of participants experienced sexual abuse (39.2%), losing a job (24.3%) or physical abuse (23.6%) because of their transgender identity”.

LGBTIQ activist Srun Srorn said discrimination and stigmatisation were the main factors leading to high infection rates. “[Risky] behaviour is not only prevalent amongst transgenders, it’s young people; but [other] young people have access to information,” he said.

“The majority of [transgender people] are being rejected by their parents . . . When you don’t have a home, you’re not able to access the health care system and information,” he said.

The study also found that HIV prevalence among transgender women increased over the past few years to almost 6 percent, compared to 4.2 percent in a 2012 survey, and 2.6 percent in 2010.

Yi Siyan, researcher for this study, said that when only looking at the provinces the last research focused on, the increase was even higher: “If we exclude the provinces we added, the HIV prevalence is at 7 percent, and thus clearly increased since 2012,” he said.

Siyan explained that the main reasons for the high percentage were the “unawareness of their HIV status and low condom use”.

The study showed that only 48 percent of those tested HIV-positive in the survey knew prior to the study that they carried the disease.

He added that “they’re now better accepted in society and can show themselves, and they . . . enjoy more sexual freedom, while condom use remains low”. He said that this could be explained by a lack of access to information due to a missing social support system.

The study found that HIV prevalence was highest among women between 35 and 44 years old (at 13.1 percent), and lowest among those younger than 25 years (3 percent).

However, Srorn said results would have been different if the study had included minors. “If any organisation is brave enough to conduct a survey among 14- to 18-year-olds, they will have a bigger picture. They are more sexually active If we don’t look at these, we won’t be able to create a good programme.”

But Siyan said conducting surveys with minors was difficult, as they “need the informed consent of their parents. Often they don’t live with their parents and live far away.”

The Ministry of Health and Ministry of Women’s Affairs could not be reached.