HIV continuum of care among trans women and travestis living in São Paulo, Brazil
DOI:
https://doi.org/10.11606/s1518-8787.2020054002374Palavras-chave:
Transgender Persons, Transvestism, HIV Infections, prevention & control, HIV Seroprevalence, Anti-Retroviral Agents, therapeutic use, Health Services AccessibilityResumo
OBJECTIVE: To examine the HIV care cascade among trans women and travestis in São Paulo – Brazil, the most populous city in South America. METHODS: Using data from a cross-sectional study carried out between November 2016 and May 2017 in the city of São Paulo (Divas Research). Respondent driven sampling (RDS) was used to recruit 386 transgender women and travestis who participated in a HIV risk survey and were tested for HIV. The cascade was defined as HIV prevalence, HIV diagnosed, Antiretroviral (ART) Prescription, and currently on ART. A multiple analysis model was conducted to identify the association between sociodemographics and the cascade gaps. RESULTS: Of the trans women living with HIV, 80.9% were already diagnosed, 76.6% of them had been prescribed, of which 90.3% were currently on treatment. Those who were registered in care had a higher rate of ART (aPR 2.06; 95%CI 1.09-3.88). Trans women between 31-40 years old (aPR 1.65; 95%CI 1.09-2.50) and those older than 40 (aPR 1.59; 95%CI 1.04-2.43) had higher prevalence of ART. CONCLUSIONS: Our data suggest an increase in the testing and treatment policy implementation among trans women in the city of São Paulo, although gaps have been found in the linkage to care. However, young trans women and those not registered in health care service may benefit from efforts to engage this part of the population in care to improve HIV treatment and care outcomes.
Referências
Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214-22. https://doi.org/10.1016/S1473-3099(12)70315-8
Bockting W. The impact of stigma on transgender identity development and mental health. In: Kreukels B, Steensma T, Vries A, editors. Gender dysphoria and disorders of sex development. Boston, MA: Springer; 2014. p.319-30.
Coleman E, Bockting W, Botzer M, Cohen-Ketennis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender and gender non-confirming people, version 7. mInt J Transgend. 2012;13(4):165-232. https://doi.org/10.1080/15532739.2011.700873
White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222-31. https://doi.org/10.1016/j.socscimed.2015.11.010
Pinheiro Júnior FML, Kendall C, Martins TA, Mota RMS, Macena RHM, Glick J, et al. Risk factors associated with resistance to HIV testing among transwomen in Brazil. AIDS Care. 2016;28(1):92-7. https://doi.org/10.1080/09540121.2015.1066751
Grinsztejn B, Jalil EM, Monteiro L, Velasque L, Moreira RI, Garcia AC. et al. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV. 2017;4(4):E169-76. https://doi.org/10.1016/S2352-3018(17)30015-2
Jalil EM, Wilson EC, Luz PM, Velasque L, Moreira RJ, Castro CV, et al. HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil. J Int AIDS Soc. 2017;20(1):21873. https://doi.org/10.7448/IAS.20.1.21873
Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Programa Nacional de DST e Aids. Plano Nacional de Enfrentamento da Epidemia de AIDS e das DST entre Gays, HSH e Travestis. Brasília, DF: 2007.
Medland NA, McMahon JH, Chow EPF, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic review of data sources: methodology and comparability. J Int AIDS Soc. 2015;18(1):20634. https://doi.org/10.7448/IAS.18.1.20634
Powers KA, Miller WC. Building on the HIV cascade: a complementary “HIV States and Transitions” framework for describing HIV diagnosis, care, and
treatment at the population level. J Acquir Immune Defic Syndr. 2015;69(3):341-7. https://doi.org/10.1097/QAI.0000000000000611
Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19 Suppl 2:S67-72.
https://doi.org/10.1097/01.aids.0000172879.20628.e1
Bastos FI, Bastos LS, Coutinho C, Toledo L, Mota JC, Velasco-de-Castro CA, et al. HIV, HCV, HBV, and syphilis among transgender women from Brazil. Medicine (Baltimore). 2018;97(1 Suppl 1):S16-24. https://doi.org/10.1097/MD.0000000000009447
Ministério da Saúde (BR), Departamento de Condições Crônicas e Infecçôes Sexualmente Transmissíveis. Relatório de monitoramento clínico do HIV 2018. Brasília, DF; 2018.
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3;21. https://doi.org/10.1186/1471-2288-3-21
Deeks SG, Lewin SR, Havlir D V. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525-33. https://doi.org/10.1016/S0140-6736(13)61809-7
Rohe K. Network driven sampling: a critical threshold for design effects. Ithaca, NY: arXiv, Cornell University; 2017 [cited 2019 Jul 21]. Available from:
https://arxiv.org/pdf/1505.05461.pdf
Ministério da Saúde (BR), Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Brasília, DF; 2013.
Ministério da Saúde (BR), Secretaria de Políticas de Saúde, Coordenação Nacional de DST e Aids. Política Nacional de DST/Aids, princípios, diretrizes e estratégias. Brasília, DF; 1999.
Costa AB, Fontanari AMV, Catelan RF, Schwarz K, Stucky JL, Rosa Filho HT, et al. HIV - related healthcare needs and access barriers for Brazilian transgender and gender diverse people. AIDS Behav. 2018;22(8):2534-42. https://doi.org/10.1007/s10461-017-2021-1
Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22-9.
https://doi.org/10.1016/j.socscimed.2013.02.019
Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Erwin PJ, Montori VM. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality
of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010;72(2):214-31. https://doi.org/10.1111/j.1365-2265.2009.03625.x
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med.
;365(6):493-505. https://doi.org/10.1056/NEJMoa1105243
Harper GW, Jadwin-Cakmak LA, Popoff E, Campbell BA, Granderson R, Wesp LM. Transgender and other gender-diverse youth’s progression through the HIV continuum of care: socioecological system barriers. AIDS Patient Care STDS. 2019;33(1):32-43. https://doi.org/10.1089/apc.2018.0078
Baguso GN, Turner CM, Santos GM, Raymond HF, Dawson-Rose C, Lin j, et al. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc. 2019;22(4):e25270. https://doi.org/10.1002/jia2.25270
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