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Toledo LDSG, Palmieri P, Ribeiro GDR, Silva AD, Bastos FI. Barriers and facilitators for HIV rapid testing among transgender women and gay and other men who have sex with men in Brazil: A scoping review. Glob Public Health 2024; 19:2360982. [PMID: 38937916 DOI: 10.1080/17441692.2024.2360982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs' recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN' 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.
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Affiliation(s)
| | - Paloma Palmieri
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Gizele da Rocha Ribeiro
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adriano da Silva
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Mayer KH, Allan-Blitz LT. Post-exposure prophylaxis to prevent HIV: new drugs, new approaches, and more questions. Lancet HIV 2023; 10:e816-e824. [PMID: 37952551 DOI: 10.1016/s2352-3018(23)00238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023]
Abstract
Post-exposure prophylaxis (PEP) to prevent HIV acquisition has been recommended for over three decades, but remains underutilised. Over the past decade, clinical trials have established the safety and tolerability of newer PEP regimens, particularly those containing integrase strand transfer inhibitors (INSTIs) combined with a tenofovir and lamivudine or emtricitabine backbone. Several of these regimens were better tolerated than historical controls. Studies in macaques found that shorter courses of PEP with INSTIs were effective, particularly if dosing occurred close to the time of retroviral exposure. Despite the increase in well tolerated options, PEP seems to be underused globally and links to other prevention services are suboptimal. Interventions to increase provider and community awareness of PEP are needed.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Subramanian S, Namusoke-Magongo E, Edwards P, Atujuna M, Chimulwa T, Dow D, Jalil E, Torbunde N, Agot K, Arinaitwe I, Beizer J, Chelwa N, Mbalinda SN, Miti S, Mwangwa F. Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation. AIDS Behav 2023; 27:50-63. [PMID: 35841465 PMCID: PMC9287816 DOI: 10.1007/s10461-022-03787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | | | - Dorothy Dow
- Duke Global Health Institute, Durham, NC, USA
| | | | | | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Jenny Beizer
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | | | | | - Sam Miti
- Copperbelt University School of Medicine, Ndola, Zambia
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Carvalho AM, Bertoni N, Coutinho C, Bastos FI, Fonseca VDM. Tobacco use by sexual and gender minorities: findings from a Brazilian national survey. BMJ Open 2023; 13:e065738. [PMID: 37045563 PMCID: PMC10106026 DOI: 10.1136/bmjopen-2022-065738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE The study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users' profile and associations between tobacco use and social and behavioural variables. METHODOLOGY The study used data from a representative nationwide household survey of the Brazilian population aged 12-65 years-the first one to address the issue of sexual orientation/gender identity. The study sample consisted of 15 801 individuals. Social and behavioural characteristics and the use of tobacco products were compared according to sexual orientation/gender identity. A multivariate logistic model was constructed to assess the association between tobacco use and sexual orientation/gender identity, as well as models stratified by SGM and non-SGM. RESULTS Prevalence of any tobacco product use was 44.7% among SGM and 17.0% among non-SGM. Water pipe use was ~8 times higher for SGM than for non-SGM (13.5% vs 1.6%). SGM tobacco users were younger and had more schooling than non-SGM tobacco users. After adjusting for social and behavioural variables, the multivariate model showed that SGM were 150% more likely to use tobacco products than non-SGM (adjusted OR 2.52; 95% CI 1.61 to 3.95). In the model for SGM, schooling, alcohol consumption, illicit drug consumption, violence and anxiety/depression were significantly associated with tobacco use. CONCLUSION Prevalence of tobacco use among SGM was higher than among non-SGM, and the profile of tobacco users differed between them. It is urgent to monitor health issues in SGM in Brazil and to adopt tobacco control strategies for this group.
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Affiliation(s)
| | - Neilane Bertoni
- Division of Population Research, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Carolina Coutinho
- Getúlio Vargas Foundation School of Business Administration of Sao Paulo, Sao Paulo, Brazil
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Teng F, Sha Y, Fletcher LM, Welsch M, Burns P, Tang W. Barriers to uptake of PrEP across the continuum among transgender women: A global scoping review. Int J STD AIDS 2023; 34:299-314. [PMID: 36793197 DOI: 10.1177/09564624231152781] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Although preexposure prophylaxis (PrEP) has demonstrated high efficacy for HIV prevention, rates of PrEP uptake remain low among the transgender population, especially in transgender women (TGW). We conducted this scoping review to assess and characterize barriers to PrEP use along the PrEP care continuum among TGW. METHODS We conducted this scoping review by searching studies in Embase, PubMed, Scopus, and Web of Science. Eligibility criteria included: reporting a PrEP related quantitative result among TGW; peer-reviewed and published in English between 2010-2021. RESULTS Globally, high willingness (80%) to use PrEP was found, yet uptake and adherence (35.4%) were low. TGW experiencing hardship, including poverty, incarceration, and substance use, were associated with higher odds of PrEP awareness but lower odds of PrEP use. Structural and social barriers such as stigma, medical mistrust, and perceived racism can be important barriers for PrEP continuation. High social cohesion and hormone replacement therapy were associated with greater odds of awareness. In addition, our study confirmed prior research showing that PrEP does not lower feminizing hormone levels in TGW. CONCLUSIONS Significant demographic factors among TGW that are associated with PrEP engagement. It is imperative to focus on TGW as a population with independent needs, requiring specific PrEP care guidelines and tailored resource allocation, that fully considers individual-, provider-, and community/structural-level barriers and facilitators. The present review also indicates that combining PrEP care with GAHT or broader gender-affirmation care may facilitate PrEP use.
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Affiliation(s)
- Fei Teng
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Yongjie Sha
- 568921University of North Carolina Project-China, Guangzhou, China
| | - Lauren M Fletcher
- Department of Academic Affairs, Rowland Medical Library, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Welsch
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Paul Burns
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, 568921University of North Carolina Project-China, Guangzhou, China
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Jalil EM, Wilson E, Monteiro L, Varggas T, Moura I, Torres TS, Hoagland B, Cardoso SW, Ismerio Moreira R, Gonçalves Veloso Dos Santos V, Grinsztejn B. A Peer-Led Digital Intervention to Reduce HIV Prevention and Care Disparities Among Young Brazilian Transgender Women (The BeT Study): Protocol for an Intervention Study. JMIR Res Protoc 2023; 12:e44157. [PMID: 36735296 PMCID: PMC9938440 DOI: 10.2196/44157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The HIV epidemic continues to disproportionately burden marginalized populations despite the availability of effective preventive and therapeutic interventions. Transgender women are severely affected by HIV worldwide including in Brazil and other low- and middle-income countries, with evidence of increasing new infections among young people. There is an urgent need for youth-specific HIV prevention and care interventions for young transgender women in Brazil. OBJECTIVE This study aims to (1) address stigma in the Brazilian public health system and (2) reduce barriers to HIV care and prevention with systems navigation among young transgender women aged 18-24 years in Rio de Janeiro, Brazil. METHODS The Brilhar e Transcender (BeT) study is a status-neutral, peer-led, single-arm digital intervention study enrolling 150 young transgender women in Rio de Janeiro, Brazil. The intervention was pilot tested and refined using data from a formative phase. The BeT intervention takes place over 3 months, is delivered remotely via mobile phone and in person by peers, and comprises three components: (1) BeT sessions, (2) digital interactions, and (3) automated messages. Eligibility criteria include identifying as transgender women, being aged 18-24 years, speaking in Portuguese, and living in the Rio de Janeiro metropolitan area in Brazil. The primary outcomes are HIV incidence, pre-exposure prophylaxis uptake, linkage to HIV care, and viral suppression. Primary outcomes were assessed at baseline and quarterly for 12 months. Participants respond to interviewer-based surveys and receive tests for HIV and sexually transmitted infections. RESULTS The study has been approved by the Brazilian and the US local institutional review boards in accordance with all applicable regulations. Study recruitment began in February 2022 and was completed in early July 2022. Plans are to complete the follow-up assessment of study participants on July 2023, analyze the study data, and disseminate intervention results by December 2023. CONCLUSIONS Interventions to engage a new generation of transgender women in HIV prevention and care are needed to curb the epidemic. The BeT study will evaluate a digital peer-led intervention for young transgender women in Brazil, which builds on ways young people engage in systems and uses peer-led support to empower transgender youth in self-care and health promotion. A promising evaluation of the BeT intervention may lead to the availability of this rapidly scalable status-neutral HIV intervention that can be translated throughout Brazil and other low- and middle-income countries for young transgender women at high risk of or living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT05299645; https://clinicaltrials.gov/ct2/show/NCT05299645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44157.
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Affiliation(s)
- Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Erin Wilson
- Center for Public Health Research, San Francisco, Department of Public Health, San Francisco, CA, United States
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Thaylla Varggas
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Isabele Moura
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Thiago S Torres
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo Ismerio Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Jalil EM, Torres TS, Luz PM, Monteiro L, Moreira RI, de Castro CRV, Leite IDC, Cunha M, de Cássia Elias Estrela R, Ramos M, Hoagland B, Wagner Cardoso S, Anderson P, Veloso VG, Wilson E, Grinsztejn B. Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study. J Int AIDS Soc 2022; 25:e25896. [PMID: 35255199 PMCID: PMC8901149 DOI: 10.1002/jia2.25896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/08/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction We aimed to evaluate daily oral pre‐exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non‐attendance and low PrEP adherence in a Brazilian trans‐specific 48‐week study (PrEParadas). Methods We enrolled transgender women (TGW) engaging in high‐risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p‐value<0.10 in the univariate analysis. Results From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non‐attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18–24 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09–36.7) and 25–34 years (aOR = 6.79, 95% CI: 1.72–26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37–18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30–34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94–47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16–0.88). No participant seroconverted over the course of the study. Conclusions Although high PrEP retention can be achieved in a gender‐affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale‐up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.
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Affiliation(s)
- Emilia M Jalil
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Thiago S Torres
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - Iuri da C Leite
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | - Marcello Cunha
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | | | - Michelle Ramos
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Peter Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Valdilea G Veloso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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de Sousa Mascena Veras MA, Saggese GSR, Gomez JL, Silveira P, Paiatto B, Ferreira D, de Souza PA, Calado R, Castejon MJ, Yamashiro R, de Macedo Brígido LF, Turner C, Lin J, Wilson EC, McFarland W. Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil. J Acquir Immune Defic Syndr 2021; 88:e1-e4. [PMID: 34050104 PMCID: PMC8373663 DOI: 10.1097/qai.0000000000002737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transgender women worldwide have the highest prevalence of HIV and the lowest access to prevention among groups at risk of HIV. However, few longitudinal studies have directly measured HIV incidence and identified predictors of HIV acquisition among transgender women. SETTING São Paulo, Latin America's largest city. METHODS We conducted a longitudinal study among transgender women in São Paulo. Participants were recruited by a long-chain peer referral process from May 2017 to July 2019. Those aged 18 years and older and who were HIV-negative at baseline were retested every 6 months up to 18 months. HIV incidence was calculated by dividing the number of seroconversions by the person-years (PYs) of follow-up; 95% confidence intervals (CIs) were constructed assuming a Poisson distribution. Conditional maximum likelihood ratios assessed differences in HIV incidence by risk factors. RESULTS A racially/ethnically diverse sample of 545 HIV-negative transgender women was enrolled. In 485.5 PYs of follow-up, 13 seroconversions were observed, yielding an incidence of 2.68 per 100 PYs (95% CI: 1.43 to 4.58). HIV incidence was significantly higher among transgender women aged 18-24 years (rate ratio 3.85, 95% CI: 1.24 to 12.93) and among those who engaged in sex work in the preceding month (rate ratio 5.90, 95% CI: 1.71 to 26.62). CONCLUSIONS HIV transmission continues at a high rate among transgender women in Brazil. Factors such as young age, lower level of education, and limited employment opportunities may lead to dependence on sex work that in turn increases HIV risk. Transgender-friendly prevention services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.
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Affiliation(s)
| | | | - José Luis Gomez
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paula Silveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo, Brazil
| | - Beatriz Paiatto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Denis Ferreira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paola Alves de Souza
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Psicologia Social, Universidade de São Paulo, Brazil
| | - Rodrigo Calado
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Márcia Jorge Castejon
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | - Rosemeire Yamashiro
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | | | - Caitlin Turner
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Jess Lin
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
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Jalil EM, Wilson EC, Monteiro L, de Velasque LS, Ferreira ACG, Nazer SC, Friedman RK, Veloso VG, Levi JE, Grinsztejn B. High prevalence of anal high-risk HPV infection among transwomen: estimates from a Brazilian RDS study. J Int AIDS Soc 2021; 24:e25691. [PMID: 33773075 PMCID: PMC8002898 DOI: 10.1002/jia2.25691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION As the leading sexually transmitted infection worldwide, human papillomavirus (HPV) may disproportionately affect transwomen. We aimed to estimate anal HPV prevalence, especially focusing on high-risk (hr)-HPV types and evaluate their associated factors among transwomen living in Rio de Janeiro, Brazil. METHODS Transwomen enrolled in a respondent-driven sampling (RDS)-based survey conducted between August 2015 and January 2016 self-collected anal samples, which were promptly stored at minus 80°C. After DNA extraction, HPV detection and genotyping were performed using the PapilloCheck test. We estimated HPV prevalences and evaluated the correlates of anal hr-HPV infection using a regression logistic model. RESULTS Out of 345 transwomen, 272 (78.8%) were included in this analysis (122 [44.9%] HIV-positive). No participant had ever received HPV vaccination. Among participants enrolled, 212 (77.9%) were positive for any anal HPV type and 165 (60.7%) for hr-HPV. Most common hr-HPV were as follows: HPV16 (17.6%), HPV68 (14.7%), HPV39 (14.3%), HPV56 (12.5%), HPV51 (11.4%) and HPV52 (11.0%). HIV-positive transwomen had three times the odds of having an hr-HPV compared to HIV-negative transwomen. Participants who had a current rectal Neisseria gonorrhoeae infection had 3.7 times the odds of being coinfected with hr-HPV. Among HIV-positive transwomen, neither antiretroviral therapy use, undetectable viral load, current and nadir CD4 counts were associated with anal hr-HPV infection. CONCLUSIONS Brazilian transwomen in our study exhibit some of the highest population-specific rates of HPV and hr-HPV. There is an urgent need to elucidate the burden of HPV infection, prevalence of HPV-related diseases and access to and uptake of HPV vaccination among transwomen, especially from low- and middle-income settings.
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Affiliation(s)
- Emilia M Jalil
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Erin C Wilson
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Laylla Monteiro
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Luciane S de Velasque
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
- Mathematics and Statistics DepartmentUNIRIORio de JaneiroBrazil
| | | | - Sandro C Nazer
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Ruth K Friedman
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Valdilea G Veloso
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
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