Plenty of transsexuals in Western society, both female and male, just more acceptable here, so they come out.That's my theory. Who looks twice at a ladyboy or Tom. Having said that you present as female, you'd better make a good job of it, or you're gonna be a joke, Toms seem to have more leeway, I'm jealous, how do these fat guys/girls get such sexy women. Like guys are killing themselves to get ripped, in the hope this is gonna attract females, and the only people they attract are other guys.
In Westen society I've personally met (i.e, spoke to as opposed to read about in the media) three, here they're everywhere. No doubt a lot of the guys are secretly trying out their wives' underwear.
As for HIV - anal sex is conducive to spreading the disease, combine that with a p4p culture, and a reluctance to use condoms; well, the results are pretty predictable.
Life's a joke.