Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil

Abstract

Background The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen, and identify the factors associated with newly diagnosed HIV infections. Methods “Transcender” was a respondent driven sampling study of transwomen in Rio de Janeiro, Brazil, conducted from August 2015 to January 2016. Twelve seeds were recruited from social movements and formative phase. Eligibility criteria were: self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or metropolitan area, and having a valid peer recruitment coupon. Participants were categorized as HIV-negative, known HIV infected, or newly diagnosed as HIV infected. Predictors of newly diagnosed HIV infections were assessed by comparing the newly diagnosed with the HIV-negative. Population estimates were adjusted using the RDSII estimator. Findings In total, 345 eligible transwomen were enrolled. The study sample was young and diverse on gender identity. Population estimates of no prior HIV testing, HIV-infection and newly diagnosed as HIV-infected were 29·1%, 32·1% and 7·0%, respectively (based on n=60 with no prior testing, n=141 HIV-infected, n=40 newly diagnosed). Syphilis, rectal chlamydia and gonorrhea infection were diagnosed in 28·9%, 14·6%, and 13·5%, respectively. Newly diagnosed HIV infections were associated with black race (22·8; 95%CI 2·9–178·9), travesti (34·1; 95%CI 5·8–200·2) or transsexual woman (41·3; 95%CI 6·3–271·2) gender identity, history of sex work (30·7; 95%CI 3·5–267·3), and history of sniffing cocaine (4·4; 95%CI 1·4–14·1). Interpretation Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health care and prevention services in order to curb the HIV epidemic and improve the quality-of-life of transwomen in Brazil. Funding This work was supported by Brazilian Research Council (470056/2014-2) and NIAID-NIH (UM1AI069496).

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

“…We found that black racial identity, low income and unstable housing were associated with significantly lower odds of viral suppression. In the study overall (i.e., Transcender) and a recent study of MSM in Rio de Janeiro, newly diagnosed HIV infection was associated with non-white race [8,15]. And research from San Francisco has shown that housing instability [13] and low income [16] is associated with poor viral suppression.…”

“…To participate, individuals had to self-identify as a transwoman, living in Rio de Janeiro or the metropolitan area, and be age 18 years or older. Details of the study methodology have been described elsewhere [8]. In brief, based on formative focus group findings, twelve seeds were selected to ensure that the sample was not over-represented by key variables, e.g.…”

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

“…The reason for the association of non‐hormone use and HIV is not clear from our data. In other settings, lack of hormone use was associated with specific gender identities, such as “travesti” in Rio de Janeiro and “transsexual” in San Francisco , which in turn were groups with higher prevalence of HIV. These groups of transgender women may not be on feminizing hormone therapy because they cannot afford or do not desire the feminizing effects of oestrogen, thus transgressing gender norms in the trans and cisgender women communities.…”

The cost‐effectiveness of HIV pre‐exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil

“…We simulated HIV‐uninfected MSM and TGW at high risk of HIV infection in Brazil, modelling them as one population. While TGW experience a higher disease burden than MSM in Brazil , we combined the two populations because a PrEP programme in Brazil would likely target both. In the No PrEP strategy, individuals faced a monthly risk of HIV infection and were randomly tested for HIV at a rate of 4.4% per year (corresponding to a ~50% expected probability of being tested at least once over a lifetime) as per testing rates observed in this population in Brazil.…”

“…In 2007, 30.8% of those newly diagnosed with HIV infection reported sex with other men as the mode of HIV acquisition; by 2016, this proportion reached 50.2% . HIV risk is even more pronounced among TGW ; in Rio de Janeiro, Brazil, their HIV prevalence is estimated at 31.2% .…”