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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Luz PM, Spaeth H, Scott JA, Grinsztejn B, Veloso VG, Freedberg KA, Losina E. Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation. Braz J Infect Dis 2024; 28:103722. [PMID: 38369294 PMCID: PMC10897846 DOI: 10.1016/j.bjid.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/24/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.
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Affiliation(s)
- Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Hailey Spaeth
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Justine A Scott
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Elena Losina
- Harvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Alves-da-Silva CR, Bonan C, Gomes SCDS, Vieira RS. Detection of sexually transmitted infections among transvestites and transsexual women in prison in the metropolitan region of Rio de Janeiro, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230058. [PMID: 38088717 PMCID: PMC10715320 DOI: 10.1590/1980-549720230058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To evaluate the seropositivity rate of rapid tests for HIV, syphilis and hepatitis B and C among transvestites and transgender women (transfeminine persons) inmates in the metropolitan region of Rio de Janeiro, analyzing the results based on sociodemographic, prison profile and access to health technologies to prevent sexually transmitted infections (STIs). METHODS Cross-sectional census-type study carried out with transfeminine in eleven male prisons in Rio de Janeiro, between the months of April and June 2021. RESULTS The detection rates found were 34.4% for HIV, and 48.9% for syphilis, and 0.8% for type B and C hepatitis. Seropositivity for more than one infection was verified in 25.4% of participants, and HIV/syphilis was the most prevalent. An increase in the level of education (p=0.037) and having a steady partner in prison (p=0.041) were considered protective factors for STIs in this population. Difficulties were identified in accessing STI prevention technologies, such as male condoms, lubricating gel, rapid tests, and prophylactic antiretroviral therapies for HIV. CONCLUSION HIV and syphilis seropositivity rates were high, but within the profile found in this population in other studies inside or outside prisons. The data found indicates the need to incorporate effective strategies for access to health technologies for the prevention of STIs. The scarcity of scientific publications containing epidemiological data on STIs in the transfeminine prison population limited deeper comparisons of the results obtained in this study.
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Affiliation(s)
- Carlos Renato Alves-da-Silva
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira – Rio de Janeiro (RJ), Brazil
- State Secretariat for Penitentiary Administration, LGBTI Health and Citizenship Support Division – Rio de Janeiro (RJ), Brazil
| | - Claudia Bonan
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira – Rio de Janeiro (RJ), Brazil
| | - Saint Clair dos Santos Gomes
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira – Rio de Janeiro (RJ), Brazil
| | - Rosilene Santarone Vieira
- Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira – Rio de Janeiro (RJ), Brazil
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Mesías-Gazmuri J, Folch C, Ferrer L, Reyes-Urueña J, Egea-Cortés L, Morales A, Villegas L, Casabona J. Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project. Int J Behav Med 2023; 30:824-835. [PMID: 36333554 DOI: 10.1007/s12529-022-10138-x] [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] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transgender women and cisgender men sex workers are vulnerable to HIV and sexually transmitted infections (STIs). This study aimed to explore in depth the prevalence of syndemic conditions and their association with the sexual risk behaviors for HIV/STI acquisition in cis men and trans women sex workers in Barcelona (Catalonia, Spain). METHOD We conducted a study between 2014 and 2018 to determine whether syndemic conditions (frequent alcohol consumption and polydrug use (> 2) during sex with clients; experience of violence; and lack of healthcare access) are associated with HIV/STI sexual risk behaviors. A "syndemic index" was calculated based on the cumulative number of syndemic conditions (0 to 4). RESULTS In the last year (2018), 78.8% of cisgender men and 68.1% of transgender women reported at least one syndemic condition. The most prevalent syndemic factor in both cisgender men and transgender women was violence (38.8% and 43.6% respectively). In multivariable analysis, an association was found between condomless anal sex and violence (aOR = 1.81), and frequent alcohol consumption and violence with reporting > 10 clients/week (aOR = 2.73 and 1.88, respectively). The higher the number of syndemic factors, the greater probability of having > 10 clients/week and reporting condomless anal sex with clients. CONCLUSION Psychosocial conditions have a syndemic effect on risky sexual behaviors highlighting the need for a more holistic approach to HIV/STI prevention targeting these populations.
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Affiliation(s)
- Jocelyn Mesías-Gazmuri
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- Doctorat Metodologia de La Recerca Biomèdica I Salut Publica, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cinta Folch
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain.
| | - Laia Ferrer
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Laia Egea-Cortés
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
| | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias I Pujol, Carretera de Can Ruti, Edifici MuntanyaCamí de Les Escoles S/N, 08916, Badalona (Barcelona), Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
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Morel Z, Aguilar G, Samudio T, López G, Rios-González CM, Giménez L, Schaerer C, Gómez S, Báez T, Estigarribia G, Méndez J, Muñoz S, McFarland W. Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay. HIV Med 2023; 24:990-999. [PMID: 37128161 PMCID: PMC10792994 DOI: 10.1111/hiv.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay. METHODS Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021. RESULTS In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38). CONCLUSIONS Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.
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Affiliation(s)
- Zoilo Morel
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
| | - Gloria Aguilar
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
- Departamento de Salud Pública, Universidad de la Frontera. Temuco, Chile
| | - Tania Samudio
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | - Gladys López
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | | | - Liliana Giménez
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | - Christian Schaerer
- Polytechnic School, National University of Asuncion, San Lorenzo. Paraguay
| | - Santiago Gómez
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
| | | | - Gladys Estigarribia
- Universidad Nacional de Caaguazu. Regional Health Research Institute. Paraguay
| | - Julieta Méndez
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
- Universidad Nacional de Caaguazu. Regional Health Research Institute. Paraguay
| | - Sergio Muñoz
- Departamento de Salud Pública, Universidad de la Frontera. Temuco, Chile
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health. San Francisco, CA, USA
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Bocage AE, Coelho LE, Lake JE, Clark JL, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Veloso VG, Grinsztejn B, Luz PM. The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019-2021: Disparities by Age and Gender. AIDS Behav 2023; 27:2629-2641. [PMID: 36715887 PMCID: PMC9885404 DOI: 10.1007/s10461-023-03988-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
We evaluated COVID-19's impact on HIV care indicators among INI/FIOCRUZ's HIV Clinical Cohort in Rio de Janeiro, Brazil: (1) Adequate care visits: two visits ≥ 90 days apart; (2) Adequate viral load monitoring: ≥ 2 viral load results ≥ 90 days apart; (3) Consistent viral suppression: all viral loads < 40 copies/mL; and (4) ART medication possession ratio (MPR) ≥ 95%. Chi-square tests compared the fraction of participants meeting each indicator per period: pre-pandemic (3/1/2019-2/29/2020) and post-pandemic (3/1/2020-2/28/2021). Logistic regression models were used to assess disparities in adequate care visits. Among 906 participants, care visits and viral load monitoring decreased pre-pandemic to post-pandemic: 77.0-55.1% and 36.6-11.6% (both p < 0.001), respectively. The optimal MPR rate improved from 25.5 to 40.0% (p < 0.001). Post-pandemic period (aOR 0.33, CI 0.28-0.40), transgender women (aOR 0.34, CI 0.22-0.53), and those aged 18-24 years (aOR 0.67, CI 0.45-0.97) had lower odds of adequate care visits. COVID-19 disrupted care access disproportionately for transgender women and younger participants.
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Affiliation(s)
- Anne E Bocage
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- The Warren Alpert Medical School of Brown University, 222 Richmond St, Box G-M117, Providence, RI, 02912, USA.
| | - Lara E Coelho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UTHealth Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Thiago S Torres
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Emília M Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- 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
| | - Paula M Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Cattani VB, Jalil EM, Eksterman L, Torres T, Wagner Cardoso S, Castro CRV, Monteiro L, Wilson E, Bushman L, Anderson P, Veloso VG, Grinsztejn B, Estrela R. Estradiol and Spironolactone Plasma Pharmacokinetics Among Brazilian Transgender Women Using HIV Pre-Exposure Prophylaxis: Analysis of Potential Interactions. Clin Pharmacokinet 2023; 62:1031-1041. [PMID: 37261664 PMCID: PMC10338392 DOI: 10.1007/s40262-023-01248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE An important barrier to HIV prevention among transgender women (TGW) is the concern that oral pre-exposure prophylaxis (PrEP) negatively affects the efficacy of feminizing hormone therapy (FHT). We aimed to assess the impact of PrEP on FHT pharmacokinetics (PK) among TGW from Brazil. METHODS We performed a drug-drug interaction sub-study among TGW enrolled in a daily oral PrEP demonstration study (PrEParadas, NCT03220152). Participants had a first PK assessment (PK1) 15 days after FHT (estradiol valerate 2-6 mg plus spironolactone 100-200 mg) initiation and then started PrEP (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg). A second PK evaluation was performed 12 weeks later (PK2). Blood samples were collected prior and after the directly observed dosing (0, 0.5, 1, 2, 4, 6, 8, and 24 hours). Pharmacokinetic parameters of estradiol, spironolactone, and metabolites were estimated by non-compartmental analysis (Monolix 2021R2, Lixoft®) and compared as geometric mean ratios (GMRs, 90% confidence interval [CI]). RESULTS Among 19 TGW who completed the substudy, median age was 26 years (interquartile range: 23-27.5). Estradiol area under the plasma concentration-time curve (AUCτ) and trough concentrations did not differ between PK1 and PK2 evaluations (GMR [90% CI]: 0.89 [0.76-1.04] and 1.06 [0.94-1.20], respectively). Spironolactone and canrenone AUCτ were statistically lower at PK2 than PK1 (0.76 [0.65-0.89] and 0.85 [0.78-0.94], respectively). Canrenone maximum concentration was also lower at PK2 than PK1 (0.82 [0.74-0.91]). CONCLUSION Estradiol PK was not influenced by PrEP concomitant use. The small differences observed in some spironolactone and canrenone PK parameters should not prevent the concomitant use of estradiol-based FHT and PrEP. TRIAL REGISTRATION This trial (NCT03220152) was registered on July 18, 2017.
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Affiliation(s)
- Vitória Berg Cattani
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil.
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Eksterman
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Thiago Torres
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Cristiane R V Castro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- University of California, San Francisco, USA
| | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Rita Estrela
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil.
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Neduzhko O, Saliuk T, Kovtun O, Semchuk N, Varetska O. Community-based HIV prevention services for transgender people in Ukraine: current situation and potential for improvement. BMC Health Serv Res 2023; 23:631. [PMID: 37316821 PMCID: PMC10268490 DOI: 10.1186/s12913-023-09656-5] [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: 08/24/2022] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Community-based HIV-prevention services are a key approach to prevent HIV transmission among key population representatives. Transgender people have multiple specific needs and it is crucial to use prevention approaches that effectively respond to those needs and facilitate barriers on the way to use HIV prevention and related services. This study is aimed to explore the current state of community-based HIV prevention services among transgender people in Ukraine, its limitations and potential for improvement based on the experience and perceptions of transgender people, physicians, and community social workers providing services to transgender people. METHODS Semi-structured in-depth interviews were conducted among physicians providing services to transgender people (N = 10), community social workers (N = 6), and transgender people (N = 30). The objectives of the interviews were to explore: the relevance of the community-based HIV prevention services to the needs of transgender people; the key components of the most preferred ("ideal") HIV-prevention package for transgender people; ways to optimize the existing HIV prevention package for transgender people including enrollment and retention. Systematically collected data were analyzed and coded into the main domains, thematic categories and subcategories using thematic analysis. RESULTS The current HIV prevention programs were well-evaluated by the majority of respondents. Gender-affirming care was found to be the key need of transgender people. Integration of HIV prevention services and gender-affirming care was perceived as the main way to address the needs of transgender people. Internet-based and peer word-of-mouth recruitment may improve enrollment in services. Optimization of existing HIV prevention package may include: psychological counseling, referral and navigation to medical services, legal services, pre- and post-exposure prevention, dissemination of tube lubricants, femidoms and latex wipes, use of oral fluid test systems for HIV self-testing. CONCLUSIONS The findings of this study suggest potential solutions to improve community-based HIV prevention services for transgender people by introducing a transgender people -oriented package, which integrates gender transition, HIV prevention and other services. Provision of prevention services based on assessed risk and referral/navigation to related services are the key options for optimization of the existing HIV prevention package. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Oleksandr Neduzhko
- Ukrainian Institute on Public Health Policy, 5 Biloruska Str. Office 20, 27, Kyiv, 04050, Ukraine.
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Coelho LE, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Calvet GA, Pacheco AG, Veloso VG, Grinsztejn B, Luz PM. Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102740. [PMID: 36736374 PMCID: PMC9931919 DOI: 10.1016/j.bjid.2023.102740] [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] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. METHODS We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. RESULTS Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. CONCLUSION We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.
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Affiliation(s)
- Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Thiago S Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Emilia M Jalil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ronaldo I Moreira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Guilherme A Calvet
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Antônio G Pacheco
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, RJ, Brazil
| | - Valdiléa G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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Bassichetto KC, Saggese GSR, Maschião LF, Carvalho PGCD, Gilmore H, Sevelius J, Lippman SA, Veras MADSM. Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil. CAD SAUDE PUBLICA 2023; 39:e00147522. [PMID: 37132720 DOI: 10.1590/0102-311xpt147522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/27/2023] [Indexed: 05/04/2023] Open
Abstract
Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.
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Echeverría-Guevara A, Coelho LE, Veloso VG, Pimenta MC, Hoagland B, Moreira RI, Leite I, Jalil EM, Cardoso SW, Torres TS, Grinsztejn B. Travestis, transgender women and young MSM are at high risk for PrEP early loss to follow-up in Rio de Janeiro, Brazil. Braz J Infect Dis 2022; 27:102733. [PMID: 36586721 PMCID: PMC9871061 DOI: 10.1016/j.bjid.2022.102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (FTC/TDF) is highly effective in preventing HIV infection. This study aimed to identify factors associated with PrEP early loss to follow-up (ELFU) among gay, bisexual and other men who have sex with men (MSM), travestis and transgender women (TGW). METHODOLOGY This was a prospective cohort study evaluating TGW and MSM who initiated PrEP at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz) from 2014 to 2020. ELFU was defined as not returning for a PrEP visit within 180 days after first dispensation. Exposure variables included age, gender, race, education, transactional sex, condomless anal intercourse [CAI] (both in the past six months), binge drinking and substance use (both in past three months) and syphilis diagnosis at baseline. Multilevel logistic regression models with random intercepts and fixed slopes were used to identify factors associated with ELFU accounting for clustering of participants according to their PrEP initiation study/context (PrEP Brasil, PrEParadas, ImPrEP and PrEP SUS). RESULTS Among 1,463 participants, the median age was 29 years (interquartile range 24-36), 83% self-identified as MSM, 17% as TGW, 24% were black, 37% mixed-black/pardo and 30% had < 12 years of education. Fifteen percent reported transactional sex, 59% reported CAI, 67% binge drinking, 33% substance use, and 15% had a syphilis diagnosis. Overall, 137 participants (9.7%) had ELFU. Younger age (18-24 years) (adjusted odds ratio [aOR] 1.9, 95%CI:1.2-3.2), TGW (aOR 2.8, 95%CI:1.6-4.8) and education < 12 years (aOR 1.9, 95%CI:1.2-2.9) were associated with greater odds of ELFU. CONCLUSION TGW, young individuals and those with lower education were at higher risk of PrEP ELFU. Our results suggest that the development of specific strategies targeting these populations should be a priority, through policies that aim to reduce the incidence of HIV infection.
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Affiliation(s)
- Amanda Echeverría-Guevara
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Valdiléa G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Maria C. Pimenta
- Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Ministério da Saúde, Brasília, DF, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Ronaldo I. Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Iuri Leite
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Emília M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Sandra W. Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Silva MST, Coutinho C, Torres TS, Peixoto E, Ismério R, Lessa F, Nunes EP, Hoagland B, Echeverria Guevara AD, Bastos MO, Ferreira Tavares IC, Diniz Ribeiro MP, Meneguetti Seravalli Ramos MR, Andrade HB, Lovetro Santana AP, Santini-Oliveira M, Santos Netto JB, Reges P, Magalhães MA, Silva Rosadas LA, Nazer S, Velasque L, Cardoso SW, da Silva EE, Veloso VG, Wakimoto MD, Grinsztejn B, Trepow M, Ferreira IG, Villela L, Fraga RT, Castro de Souza Pires M, Otavio da Silva Escada R, Paiva de Sousa L, Umaña Robleda GL, Santos DV, Siqueira Camacho LR, Amparo P, Jaegger de França JV, de Oliveira Heluy Correa F, Costa de Sousa BI, Vicari do Valle B, Bortot Soares JP, Fonseca Ferreira LC, da Silva Martins P, Mesquita MB, Hildebrant Coutinho JR, de Moraes Perlingeiro R, Peixoto de Castro Oliveira P, Pedroso Barbosa HP, Accetta AF, Cunha M, Eiras RV, Martins dos Santos T, Davila da Silva W, Silveira MDV, de Souza Brum T, Calvet GA, Menezes RC, Pereira SA. Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil. LANCET REGIONAL HEALTH. AMERICAS 2022; 17:100406. [PMID: 36776570 PMCID: PMC9904017 DOI: 10.1016/j.lana.2022.100406] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
Background By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30-39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).
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Affiliation(s)
- Mayara Secco Torres Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eduardo Peixoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ronaldo Ismério
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Flavia Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Estevão Portela Nunes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Matheus Oliveira Bastos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Maria Pia Diniz Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Hugo Boechat Andrade
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ana Paula Lovetro Santana
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Marilia Santini-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Juliana Barbosa Santos Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Paula Reges
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Monica Avelar Magalhães
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (ICICT-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Sandro Nazer
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Matemática e Estatística, Rio de Janeiro, RJ, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Edson Elias da Silva
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (IOC-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil,Corresponding author. Av Brasil 4365 Manguinhos, Rio de Janeiro, RJ, Brazil.
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Konda KA, Torres TS, Mariño G, Ramos A, Moreira RI, Leite IC, Cunha M, Jalil EM, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista‐Arredondo S, Vega‐Ramirez H, Veloso VG, Caceres CF, Grinsztejn B. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. J Int AIDS Soc 2022; 25 Suppl 5:e25974. [PMID: 36225148 PMCID: PMC9557020 DOI: 10.1002/jia2.25974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.
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Affiliation(s)
- Kelika A. Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Gabriela Mariño
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Alessandra Ramos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Ronaldo I. Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Iuri C. Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Juan V. Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | | | | | | | - Hamid Vega‐Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente MuñizMexico CityMexico
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
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Calazans G, Facchini R. "But the category of exposure also has to respect identity": MSM, classifications and disputes in AIDS policy. CIENCIA & SAUDE COLETIVA 2022; 27:3913-3922. [PMID: 36134797 DOI: 10.1590/1413-812320222710.08142022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
This essay explores the relationship between diversity and public health by addressing tensions related to classifications and recognition in the field of HIV and AIDS policy. The objective is to reflect on how classificatory and operative categories are articulated within the scope of programmatic responses towards the social production of differences and inequalities. To do so it draws from the theoretical framework of studies on vulnerability and recognition and from a methodology that includes a critical review of the literature on the category men who have sex with men (MSM) and ethnographic material, derived from the authors' research and a literature review related to social movements, and research and policies focused on lesbians, gays, bisexuals, transvestites and transsexuals (LGBT). It reviews how the MSM category was constructed in the field of HIV and AIDS prevention policies at an international level, situating political actors and tensions. It problematizes these tensions by analyzing processes of production of political subjects as well as changes in socio-state relations that involve LGBT. It emphasizes the importance of considering how differences and inequalities emerge in socio-political processes and of dedicating studies to improve policies, ensuring an effectively more respectful care.
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Affiliation(s)
- Gabriela Calazans
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César. 05403-000 São Paulo SP Brasil.
| | - Regina Facchini
- Núcleo de Estudos de Gênero Pagu, Programa de Pós-Graduação em Antropologia Social, Programa de Pós-Graduação em Ciências Sociais, Universidade Estadual de Campinas. Campinas SP Brasil
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15
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Gusmão-Silva JV, Lichtenecker DCK, Ferreira LGA, Gois Í, Argeri R, Gomes GN, Dias-da-Silva MR. Body, metabolic and renal changes following cross-sex estrogen/progestogen therapy in a rodent model simulating its use by transwomen. J Endocrinol Invest 2022; 45:1875-1885. [PMID: 35689728 DOI: 10.1007/s40618-022-01817-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of sex steroids by trans people has been of paramount importance regarding body changes during gender transition. The objective of this study was to assess the effects of an injectable steroid combination frequently used by transwomen, namely estradiol enanthate with dihydroxyprogesterone acetophenide (E2EN/DHPA), on blood pressure and metabolic outcomes using an animal model. METHODS Two-month-old male Wistar rats were orchiectomized or sham-operated and divided into groups: (1) Sham treated with sesame oil vehicle (SG), (2) sham treated with E2EN/DHPA (SP), (3) orchiectomized rats treated with vehicle (OG), and (4) orchiectomized rats treated with E2EN/DHPA (OP), with all groups treated every 10 days for 5 months. We evaluated systolic blood pressure (SBP), body weight (BW), abdominal circumference, nasoanal length (NAL), food and water intake (FI, WI), lipid profile (triglycerides, LDL, and HDL), serum C-reactive protein (CRP), plasma concentrations of urea (URpl) and creatinine (CRpl), 24 h urinary volume (V24 h), sodium and potassium excretion (UNa+, UK+), and proteinuria. RESULTS E2EN/DHPA administration reduced BW (SP 324.5 ± 31.1; OP 291.7 ± 41.3 g) and NAL (SP 24.5 ± 0.4; OP 24.6 ± 1.0 cm), without changing blood pressure, but increased URpl concentration (SP 55.0 ± 4.8; OP 42.5 ± 8.8 mg/dL) and CRpl (SP 0.47 ± 0.05; OP 0.46 ± 0.04 mg/dL), sodium (SP 3.1 ± 0.8; OP 3.3 ± 0.4 µEq/min/kg), potassium (SP 0.91 ± 0.22; OP 0.94 ± 0.22 µEq/min/kg) excretions and urinary volume (SP 15.5 ± 2.1; OP 16.4 ± 2.9 mL/24 h). CONCLUSION Cross-sex hormone therapy with E2EN/DHPA significantly modified body characteristics in male rats, producing a feminizing change without altering blood pressure or generating harmful metabolic parameters, but larger translational studies are still needed.
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Affiliation(s)
- J V Gusmão-Silva
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - D C K Lichtenecker
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - L G A Ferreira
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
| | - Í Gois
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
| | - R Argeri
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - G N Gomes
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil.
| | - M R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
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16
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Calazans G, Facchini R. “But the category of exposure also has to respect identity”: MSM, classifications and disputes in AIDS policy. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222710.08142022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This essay explores the relationship between diversity and public health by addressing tensions related to classifications and recognition in the field of HIV and AIDS policy. The objective is to reflect on how classificatory and operative categories are articulated within the scope of programmatic responses towards the social production of differences and inequalities. To do so it draws from the theoretical framework of studies on vulnerability and recognition and from a methodology that includes a critical review of the literature on the category men who have sex with men (MSM) and ethnographic material, derived from the authors’ research and a literature review related to social movements, and research and policies focused on lesbians, gays, bisexuals, transvestites and transsexuals (LGBT). It reviews how the MSM category was constructed in the field of HIV and AIDS prevention policies at an international level, situating political actors and tensions. It problematizes these tensions by analyzing processes of production of political subjects as well as changes in socio-state relations that involve LGBT. It emphasizes the importance of considering how differences and inequalities emerge in socio-political processes and of dedicating studies to improve policies, ensuring an effectively more respectful care.
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17
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Cattani VB, Jalil EM, Eksterman L, Torres T, Cardoso SW, Castro CRV, Monteiro L, Wilson E, Bushman L, Anderson P, Veloso VG, Grinsztejn B, Estrela R. Impact of feminizing hormone therapy on tenofovir and emtricitabine plasma pharmacokinetics: a nested drug-drug interaction study in a cohort of Brazilian transgender women using HIV pre-exposure prophylaxis. J Antimicrob Chemother 2022; 77:2729-2736. [PMID: 35815666 PMCID: PMC9525093 DOI: 10.1093/jac/dkac229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Potential interactions between feminizing hormone therapy (FHT) and pre-exposure prophylaxis (PrEP) may be a barrier to PrEP use among transgender women (TGW). We aimed to assess the impact of FHT on PrEP plasma pharmacokinetics (PK) among TGW. METHODS This was a PK substudy of the effects of FHT on tenofovir disoproxil fumarate/emtricitabine nested to a trans-specific PrEP demonstration study (NCT03220152). Participants were assigned to receive PrEP only (noFHT) or standardized FHT (sFHT; oestradiol valerate 2-6 mg plus spironolactone 100-300 mg) plus PrEP for 12 weeks, after which they could start any FHT (aFHT). Short- and long-term PK assessment occurred at Weeks 12 and 30-48, respectively (plasma samples prior and 0.5, 1, 2, 4, 6, 8 and 24 h after dose). Non-compartmental PK parameters of tenofovir and emtricitabine were compared as geometric mean ratios (GMRs) between noFHT and PrEP and FHT (sFHT at short-term PK; aFHT at long-term PK) participants. RESULTS No differences in tenofovir and emtricitabine plasma PK parameters were observed between the short-term PK of noFHT (n = 12) and sFHT participants (n = 18), except for emtricitabine Cmax [GMR: 1.15 (95% CI: 1.01-1.32)], or between noFHT short-term PK and aFHT long-term PK (n = 13). Most participants were on oestradiol valerate 2 mg at the short-term PK (56%) and 4 mg at the long-term PK (54%). Median (IQR) oestradiol levels were 56.8 (43.2-65.4) pg/mL at short-term PK (sFHT) and 44.8 (24.70-57.30) pg/mL at long-term PK (aFHT). No participants in this analysis seroconverted during the study. CONCLUSIONS Our results indicate no interaction of FHT on tenofovir levels, further supporting PrEP use among TGW using FHT.
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Affiliation(s)
- Vitória Berg Cattani
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Eksterman
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Thiago Torres
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Cristiane R V Castro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- University of California, San Francisco, USA
| | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
| | - Rita Estrela
- Evandro Chagas National Institute of Infectious Diseases INI Fiocruz, Rio de Janeiro, Brazil
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Karalexi MA, Frisell T, Cnattingius S, Holmberg D, Holmberg M, Kollia N, Skalkidou A, Papadopoulos FC. Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy. Eur J Prev Cardiol 2022; 29:2017-2026. [PMID: 35778824 DOI: 10.1093/eurjpc/zwac133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/12/2022]
Abstract
AIMS We compared the incidence of cardiovascular disease (CVD) in transgender participants with a diagnosis of gender dysphoria (GD) with and without gender-affirming hormone therapy (GAHT) to the incidence observed in the general population. METHODS AND RESULTS The population-based cohort included all individuals >10 years in Sweden linked to Swedish nationwide healthcare Registers (2006-2016). Two comparator groups without GD/GAHT were matched (1:10) on age, county of residence, and on male and female birth-assigned sex, respectively. Cox proportional models provided hazard ratios (HR) and 95% confidence intervals (CI) for CVD outcomes. Among 1779 transgender individuals (48% birth-assigned males [AMAB], 52% birth-assigned females [AFAB]) 18 developed CVD, most of which were conduction disorders. The incidence of CVD for AFAB individuals with GD was 3.7 per 1000 person-years (95%CI: 1.4-10.0). AMAB individuals with GD had an incidence of CVD event of 7.1 per 1000 person-years (95%CI: 4.2-12.0). The risk of CVD event was 2.4 times higher in AMAB individuals (HR: 2.4, 95%CI: 1.3-4.2) compared to cisgender women, and 1.7 higher compared to cisgender men (HR: 1.7, 95%CI: 1.0-2.9). Analysis limited to transgender individuals without GAHT yielded similar results to those with GAHT treatment. CONCLUSION The incidence of CVD among GD/GAHT individuals was low, although increased compared to matched individuals without GD and similar to the incidence among GD/no GAHT individuals, thus not lending support for a causal relationship between treatment and CVD outcomes. Larger studies with longer follow-up are needed to verify these findings, as well as possible effect modification by comorbidity.
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Affiliation(s)
- Maria A Karalexi
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dag Holmberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Holmberg
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Natasa Kollia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Greece
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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19
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Catelan RF, Saadeh A, Lobato MIR, Gagliotti DAM, Nardi HC, Costa AB. Depression, Self-Esteem, and Resilience and its Relationship with Psychological Features of Sexuality among Transgender Men and Women from Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1993-2002. [PMID: 35414149 DOI: 10.1007/s10508-021-02189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 05/23/2023]
Abstract
This cross-sectional study investigated whether depression, self-esteem, and resilience (mental health indicators) are associated with some psychological features of sexuality (sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries) in a sample of 462 transgender men and women from Brazil. Pearson's correlations were performed between all continuous variables in the study. Those that were significantly associated with the psychological features of sexuality in previous analyses were tested as independent variables in multiple linear regression models. Sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries were negatively related to self-esteem and resilience, while positively related to depression. Higher levels of depression were associated with sexual fear, while higher levels of depression and lower self-esteem were associated with sexual anxiety. In addition, higher levels of depression and lower levels of resilience were associated with sexual dissatisfaction. Depression and resilience were associated with the composite score of sexual dissatisfaction and sexual anxiety. Our results suggest that negative mental health indicators may impair the sexual life of transgender individuals. Clinical interventions should be developed and tested to address the psychological features of sexuality.
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Affiliation(s)
- Ramiro Figueiredo Catelan
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue, 6681, Porto Alegre, 90619-900, Brazil.
| | - Alexandre Saadeh
- Transdisciplinary Gender Identity and Sexual Orientation Service (AMTIGOS-NUFOR), Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Inês Rodrigues Lobato
- Gender Identity Program (PROTIG), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Augusto Mori Gagliotti
- Transdisciplinary Gender Identity and Sexual Orientation Service (AMTIGOS-NUFOR), Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Henrique Caetano Nardi
- Department of Social Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Brandelli Costa
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue, 6681, Porto Alegre, 90619-900, Brazil
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20
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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21
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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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22
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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Carvalheira E, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service. AIDS Behav 2022; 26:2643-2652. [PMID: 35122578 DOI: 10.1007/s10461-022-03609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.
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Affiliation(s)
- Daniel R B Bezerra
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cristina M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilia M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Lara E Coelho
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Carvalheira
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Josias Freitas
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Laylla Monteiro
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Toni Santos
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cleo Souza
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Brenda Hoagland
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Thiago S Torres
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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Luz PM, Jalil EM, Castilho J, Velasque L, Ramos M, Ferreira ACG, Ferreira AL, Wilson EC, Veloso VG, Thombs BD, Moodie EE, Grinsztejn B. Association of Discrimination, Violence, and Resilience with Depressive Symptoms Among Transgender Women in Rio de Janeiro, Brazil: A Cross-Sectional Analysis. Transgend Health 2022; 7:101-106. [PMID: 35224191 PMCID: PMC8867219 DOI: 10.1089/trgh.2020.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transgender women experience violence and discrimination that lead to stress responses and contribute to poor mental health. In this analysis of baseline data from Transcendendo, a trans-specific open cohort in Rio de Janeiro, Brazil, we hypothesized that the experience of discrimination and violence would be associated with depressive symptoms and that resilience could mitigate this association. Results showed that prior experiences with discrimination and sexual and physical violence were associated with depressive symptoms, while resilience was inversely associated with depressive symptoms. Resilience did not moderate nor mediate the strong effects of discrimination and violence on depressive symptoms in adjusted models.
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Affiliation(s)
- Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Luciane Velasque
- Centro de Ciências Exatas e Tecnologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Ramos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Cristina G. Ferreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Luisa Ferreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Erin C. Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Medicine, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Psychology, and and Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - Erica E.M. Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Manzoor I, Khan ZH, Tariq R, Shahzad R. Health Problems & Barriers to Healthcare Services for the Transgender Community in Lahore, Pakistan. Pak J Med Sci 2022; 38:138-144. [PMID: 35035415 PMCID: PMC8713213 DOI: 10.12669/pjms.38.1.4375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find out the major health problems and barriers in getting health care by transgender community in Lahore, Pakistan. Methods: An analytical cross-sectional study was conducted in transgender community of Lahore from January to October 2020. The study included 214 participants from different areas of Lahore by targeting their “gurus”. Non-probability, snow-ball sampling technique was used to collect required sample size. Data was collected by using a structured questionnaire. Data were analyzed using SPSS version 23. Results were generated in form of tables and graphs. Chi square test and Fischer’s exact test were used to find out associations between health seeking behavior with their transgender status and p value was fixed as ≤ 0.05 as significant. Results: Among total 214, 78.5% were transgender females and 21.5% were transgender male. Among the common health problems were depression (56%), anxiety (59%) and genital tract ulcers (45%). About 70% transgender seek health care from government hospitals. Among total 214 participants, 70% reported that they receive poor quality of health care. The main reasons of not getting proper care is non acceptance (20.7%), feeling ashamed (28.7%), non-availability of CNIC (44.5%) and un-affordability (6.1%). Significant association of transgender female with consultation with doctors (p=0.013), seeking care at government hospitals (p =0.038) poor experience at health care facility (0.050), neglect during medical treatment (p=0.015) and feeling of discrimination during treatment (p= 0.042). Conclusion: Transgender community face physical, mental, social and reproductive health issues. About 70% trans-genders receive poor quality of health care services. Non acceptance, feeling ashamed, non-availability of CNIC and non-affordability have been reported as major barriers in getting desired health care.
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Affiliation(s)
- Iram Manzoor
- Dr. Iram Manzoor, MBBS, FCPS, MSc, MCPS-HPE, PhD. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Zartasha Hanan Khan
- Dr. Zartasha Khan, MBBS, MCPS Trainee. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rafia Tariq
- Dr. Rafia Tariq, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rijah Shahzad
- Dr. Rijah Shahzad, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
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25
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Silva MST, Jalil EM, Torres TS, Coutinho C, Jalil CM, Cardoso SW, Veloso VG, Grinsztejn B. Monkeypox and transgender women: The need for a global initiative. Travel Med Infect Dis 2022; 50:102479. [PMID: 36257591 PMCID: PMC9573897 DOI: 10.1016/j.tmaid.2022.102479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
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26
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Reis A, Sperandei S, de Carvalho PGC, Pinheiro TF, de Moura FD, Gomez JL, Porchat P, Bastos FI, McFarland W, Wilson EC, Veras MA. A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil. BMC Psychiatry 2021; 21:557. [PMID: 34758758 PMCID: PMC8579408 DOI: 10.1186/s12888-021-03557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.
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Affiliation(s)
- Arianne Reis
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Sandro Sperandei
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | - Thiago Félix Pinheiro
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ferdinando Diniz de Moura
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - José Luis Gomez
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Patrícia Porchat
- grid.410543.70000 0001 2188 478XSchool of Sciences, São Paulo State University, Bauru, Brazil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Statistics, University of California, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Trans Research unit for Equity (TRUE), San Francisco, CA USA
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
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27
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Rafael RDMR, Jalil EM, Luz PM, de Castro CRV, Wilson EC, Monteiro L, Ramos M, Moreira RI, Veloso VG, Grinsztejn BGJ, Velasque LDS. Prevalence and factors associated with suicidal behavior among trans women in Rio de Janeiro, Brazil. PLoS One 2021; 16:e0259074. [PMID: 34679106 PMCID: PMC8535442 DOI: 10.1371/journal.pone.0259074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Trans women face disproportionate burden of adverse health outcomes, including mental health issues. Very little is known about suicidal behavior among trans women in low- and middle-income settings, such as Brazil. We aimed to estimate the prevalence of lifetime suicidal behavior and to identify its associated factors among Brazilian trans women. METHODS This was a cross-sectional study conducted among 345 trans women living in Rio de Janeiro, Brazil. We examined the prevalence of suicidal behavior (ideation and suicide attempt) and its associated factors using stepwise backward Poisson regression analysis with robust variance. RESULTS Suicidal ideation was present among 47.25% of participants, and the prevalence of lifetime suicide attempt was 27.25%. Trans women with prior physical violence perpetrated by a family member had significantly higher prevalence of suicidal ideation (adjusted prevalence ratios [aPR]1.37), whereas those who reported sex work had lower prevalence ratio of suicidal ideation (aPR 0.76). Suicide attempt was significantly associated with living alone (aPR 1.48), physical violence by a casual partner (aPR 1.92), and sexual violence by a family member (aPR 1.69). Depression was significantly associated with both outcomes (aPR 1.90 for suicidal ideation and aPR 2.21 for suicide attempt). CONCLUSION Suicidal behavior prevalence rates among Brazilian trans women were alarming and directly linked to violence and poor mental health. Effective mental health and public health policies addressing violence against trans women are urgently needed to prevent suicidal behavior among this highly vulnerable population.
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Affiliation(s)
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Erin C. Wilson
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Michelle Ramos
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo Ismério Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdiléa Gonçalves Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Luciane de Souza Velasque
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Quantitative Methods, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
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28
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Monteiro Spindola Marins L, Silva Torres T, Luz PM, Moreira RI, Leite IC, Hoagland B, Kallas EG, Madruga JV, Grinsztejn B, Veloso VG. Factors associated with self-reported adherence to daily oral pre-exposure prophylaxis among men who have sex with man and transgender women: PrEP Brasil study. Int J STD AIDS 2021; 32:1231-1241. [PMID: 34311605 DOI: 10.1177/09564624211031787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Understanding the factors associated with pre-exposure prophylaxis (PrEP) adherence may help in the development of strategies to support, motivate and sustain PrEP use. This study estimated self-reported adherence, described perceived barriers and facilitators and investigated factors associated with adherence to daily oral PrEP among men who have sex with man (MSM) and transgender women after 1 year of PrEP use in Brazil. PrEP Brasil was a prospective, multicentre, open-label demonstration study with MSM and transgender women at high risk for HIV infection. We used logistic regression to evaluate factors associated with complete adherence (not forgetting to take any pills in the past 30 days) at week 48. Of 338 participants included in this analysis, 60% reported complete adherence to daily oral PrEP at week 48. Perceived barriers and facilitators to daily oral PrEP were reported by 38.2% and 98.5%, respectively. The most reported barrier and facilitator were 'I forgot to take my pills' (19.2%) and 'Associate PrEP with a daily activity/task' (58.6%), respectively. In final multivariable analysis, living in Rio de Janeiro (aOR: 0.38; 95% CI: 0.20-0.73), being transgender women (aOR: 0.22; 95% CI: 0.07-0.73), reporting stimulant use (a OR: 0.40; 95% CI: 0.20-0.80) and having any perceived barriers to daily oral PrEP (aOR: 0.12; 95% CI: 0.07-0.23) were associated with decreased odds of complete adherence. Our findings provide information for developing the best practices to promote PrEP adherence in the Brazilian context.
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Affiliation(s)
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Iuri C Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Esper G Kallas
- School of Medicine, 28133Universidade de São Paulo, São Paulo, Brazil
| | - José V Madruga
- 453682Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Catelan RF, Saadeh A, Lobato MIR, Gagliotti DAM, Costa AB. Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4850. [PMID: 34062814 PMCID: PMC8125181 DOI: 10.3390/ijerph18094850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.
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Affiliation(s)
- Ramiro Figueiredo Catelan
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre 90619-900, Brazil;
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Alexandre Saadeh
- Department of Psychology, Pontifical Catholic University of São Paulo, São Paulo 05014-901, Brazil;
- Faculty of Medicine Clinics Hospital, University of São Paulo, São Paulo 05403-000, Brazil;
| | | | | | - Angelo Brandelli Costa
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre 90619-900, Brazil;
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30
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Rodrigues A, Struchiner CJ, Coelho LE, Veloso VG, Grinsztejn B, Luz PM. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health 2021; 21:389. [PMID: 33607975 PMCID: PMC7893724 DOI: 10.1186/s12889-021-10421-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background Late antiretroviral treatment initiation for HIV disease worsens health outcomes and contributes to ongoing transmission. We investigated whether socioeconomic inequalities exist in access to treatment in a setting with universal access to care and treatment. Methods This study investigated the association of educational level, used as a proxy for socioeconomic status, with late treatment initiation and treatment initiation with advanced disease. Study participants included adults (≥25 years) who started treatment from 2005 to 2018 at Instituto Nacional de Infectologia Evandro Chagas of Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil. Educational level was categorized following UNESCO’s International Standard Classification of Education: incomplete basic education, basic education, secondary level, and tertiary level. We defined late treatment initiation as those initiating treatment with a CD4 < 350 cells/mL or an AIDS-defining event, and treatment initiation with advanced disease as those initiating treatment with a CD4 < 200 cells/mL or an AIDS-defining event. A directed acyclic graph (DAG) was constructed to represent the theoretical-operational model and to understand the involvement of covariates. Logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Multiple imputation using a chained equations approach was used to treat missing values and non-linear terms for continuous variables were tested. Results In total, 3226 individuals composed the study population: 876 (27.4%) had incomplete basic education, 540 (16.9%) basic, 1251 (39.2%) secondary level, and 525 (16.4%) tertiary level. Late treatment initiation was observed for 2076 (64.4%) while treatment initiation with advanced disease was observed for 1423 (44.1%). Compared to tertiary level of education, incomplete basic, basic and secondary level increased the odds of late treatment initiation by 89% (aOR:1.89 95%CI:1.47–2.43), 61% (aOR:1.61 95%CI:1.23–2.10), and 35% (aOR:1.35 95%CI:1.09–1.67). Likewise, the odds of treatment initiation with advanced disease was 2.5-fold (aOR:2.53 95%CI:1.97–3.26), 2-fold (aOR:2.07 95%CI:1.59–2.71), 1.5-fold (aOR:1.51 95%CI:1.21–1.88) higher for those with incomplete basic, basic and secondary level education compared to tertiary level. Conclusion Despite universal access to HIV care and antiretroviral treatment, late treatment initiation and social inequalities persist. Lower educational level significantly increased the odds of both outcomes, reinforcing the existence of barriers to “universal” antiretroviral treatment.
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Affiliation(s)
- Amanda Rodrigues
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudio J Struchiner
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Praia de Botafogo, 190, Rio de Janeiro, Brazil
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior. AIDS Behav 2021; 25:73-84. [PMID: 32737817 PMCID: PMC7394046 DOI: 10.1007/s10461-020-02984-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a web-based survey to understand the impact of social distancing measures on Brazilian MSM and transgender/non-binary lives. A total of 3486 respondents were included in this analysis and the great majority were cismen (98%). The median age was 32 years (IQR: 27-40), 44% non-white, 36% low schooling and 38% low income. Most of participants reported HIV negative/unknown status (77%). Participants on-PrEP reported more condomless anal sex than those off-PrEP. Conversely, 24% off-PrEP were at substantial HIV-risk. PrEP/ART continuation were reported by the majority, despite reports of impediments to medication refill. Transgender/non-binary reported more mental health problems and challenges to access health care. Social and racial disparities were associated with unattainability of maintaining social distancing. Tailored social and economic support policies during COVID-19 pandemic should be made available to these populations. Challenges for PrEP/ART access will demand the implementation of innovative solutions to avoid the expansion of the HIV epidemic.
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Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [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] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
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Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Wilson EC, Jalil EM, Moreira RI, Velasque L, Castro CV, Monteiro L, Veloso VG, Grinsztejn B. High risk and low HIV prevention behaviours in a new generation of young trans women in Brazil. AIDS Care 2020; 33:997-1001. [PMID: 33191759 DOI: 10.1080/09540121.2020.1844859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adult trans women in Brazil are highly impacted by HIV, but little is known about risk for young trans women. Our study was conducted to compare the HIV prevalence and correlates of risk for young trans women ages 18-24 years old to adult trans women in Brazil. Trans women were recruited from Rio de Janeiro and Baixada (the metropolitan area of Rio de Janeiro), Brazil (N = 345). Youth ages 18-24 years of age had significantly greater odds of being HIV negative than adults (OR 0.4, 95% CI 0.2-0.6, p = 0.0002), but significantly lower odds of having post-exposure prophylaxis (PEP) knowledge (OR 0.5, 95% CI:0.3-0.9, p = 0.02) and PrEP awareness (OR 0.5, 95% CI: 0.3-0.8, p = 0.01). Young trans women also had significantly higher odds of using substances (OR 1.8, 95% CI 1.1-2.9, p = 0.02) and condomless anal intercourse with their last three sexual partners (OR 1.8, 95% CI: 1.1-3.0, p = 0.03) compared to adults. Already by age 24, one in four trans women in Brazil were infected with HIV pointing to a new generation at high risk of acquiring HIV. HIV prevention interventions are needed to change the healthcare system to reach and engage young trans women.
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Affiliation(s)
- Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
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Wozniak RJ, Cerqueira NB, Dantas MCS, Mahafe B, Barros DAC, Alves de Medeiros E, Soares de Oliveira AC, Sabino T, Roggenbuck A, Avelino-Silva VI, Johnston CD, Marston JL, Bidegain SC, Magnus M, Kallas EG, Nixon DF, Donini CS. Factors associated with attitudes towards HIV cure research among transgender women and travestis: a cross-sectional survey in São Paulo, Brazil. BMJ Open 2020; 10:e040092. [PMID: 33177141 PMCID: PMC7661370 DOI: 10.1136/bmjopen-2020-040092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Characterising the perceptions of groups most affected by HIV is fundamental in establishing guidelines for biomedical advancement. Although Brazil has successfully fought HIV/AIDS through several measures, transgender women still have a likelihood of HIV infection 55 times higher than the general population. This study aimed to better understand the perception and awareness of HIV cure research among the trans-identifying population in São Paulo, Brazil, and to determine factors that motivate or discourage participation in HIV cure studies. SETTING This cross-sectional study analysed data collected from a questionnaire administered to 118 transgender women and travestis at 5 sites within the city of São Paulo. It uses quantitative methodology to describe the perspectives of transgender and travesti people in relation to HIV cure research and the context in which such perspectives are produced. RESULTS Of 118 participants, most participants (73%) had some knowledge of HIV cure research and were most willing to participate in online surveys (52%), interviews (52%), focus groups (52%) and studies involving blood draws (57%). Those with a higher education or employment status were more likely to agree that someone had been cured of HIV, people living with HIV are discriminated against, and more information about HIV cure research is needed before the community embraces it. Only 55% of participants completely trusted their physician. The biggest motivational factors included gaining additional knowledge about HIV infection (77%) and the potential for a longer, healthier life for all (73%). CONCLUSIONS As a primary analysis of HIV cure attitudes among the transgender and travesti population as well as the social context in which they are formed, this study identifies opportunities to strengthen the dialogue and develop more educational collaborations between scientific investigators, community educators and the trans-identifying population to ensure that HIV cure research is inclusive of diverse perspectives.
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Affiliation(s)
- Robert J Wozniak
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Natalia B Cerqueira
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Maria Candida S Dantas
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Bianca Mahafe
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Daniel A C Barros
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Thiago Sabino
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Albert Roggenbuck
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Carrie D Johnston
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jez L Marston
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sebastian C Bidegain
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Manya Magnus
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| | - Esper G Kallas
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Camila S Donini
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
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35
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Characterizing the role of intersecting stigmas and sustained inequities in driving HIV syndemics across low-to-middle-income settings. Curr Opin HIV AIDS 2020; 15:243-249. [PMID: 32487815 DOI: 10.1097/coh.0000000000000630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In 2020, key populations around the world still have disproportionate risks for HIV acquisition and experiencing HIV-related syndemics. This review presents current data around HIV-related syndemics among key populations globally, and on the role of intersecting stigmas in producing these syndemics in low-to-middle-income settings. RECENT FINDINGS Sex workers, sexual and gender minorities, prisoners, and people who use drugs experience high burdens of tuberculosis, sexually transmitted infections, viral hepatitis, and violence linked to heightened HIV-related risks or acquisition. Adverse sexual, reproductive, and mental health outcomes are also common and similarly amplify HIV acquisition and transmission risks, highlighting the need for psychosocial and reproductive health services for key populations. SUMMARY Achieving the promise of biomedical interventions to support HIV care and prevention requires action towards addressing syndemics of HIV, and the stigmas that reproduce them, among those most marginalized globally.
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