Sexual Behavior Transitions Among Transgender Women in Indonesia: Insights from Palembang City and Banyuasin District, South Sumatra

Despite ongoing HIV prevention efforts, risky sexual behavior among transgender women remains a major public health concern in Indonesia. However, limited evidence is available regarding the determinants of sexual behavior among transgender women. This study aimed to analyze the main determinants influencing sexual behavior among transgender women in Palembang City and Banyuasin Regency, South Sumatra, Indonesia. A quantitative ap-proach with a cross-sectional design was employed, involving 233 transgender women. Sampling was conducted using the Time Loca-tion Sampling (TLS) method in collaboration with Warna Sriwijaya Foundation between June and October 2025. Data were collected through a structured and validated questionnaire covering sociode-mographic, behavioral, and clinical factors. Bivariate analysis (chi-square test) and multivariate logistic regression were used to iden-tify predictors of risky sexual behavior, with a significance level set at p < 0.05. The results showed that 49.4% of respondents engaged in low-risk sexual behavior. The number of sexual partners was identified as the strongest predictor of risky sexual behavior (AOR = 8.891; 95% CI: 4.533–17.440; p < 0.000), followed by age at first sexual intercourse, experiences of discrimination, and lower educa-tional attainment. In contrast, higher HIV knowledge demonstrated a protective effect against risky sexual behavior. These findings highlight that early sexual initiation, multiple sexual partnerships, experiences of discrimination, and lower educational attainment remain major risk factors. Strengthening community-based HIV education and implementing anti-discrimination programs are es-sential to improving sexual health outcomes among transgender populations in Indonesia.