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      HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies

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          Abstract

          Background

          The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil.

          Methods

          The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression.

          Results

          The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV.

          Conclusion

          We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-022-14589-5.

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          Most cited references58

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          Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions.

          Jaclyn M White Hughto, Sari Reisner, John E Pachankis (2015)
          Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma.
          Article 0 comments Cited 392 times – based on 0 reviews     Review now
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            Transgender people: health at the margins of society.

            Sam Winter, Milton Diamond, Jamison Green … (2016)
            In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.
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              Syphilis and HIV: a dangerous combination.

              J. Lynn, S. L. Lightman (2004)
              HIV and syphilis affect similar patient groups and co-infection is common. All patients presenting with syphilis should be offered HIV testing and all HIV-positive patients should be regularly screened for syphilis. Syphilis agent may enhance the transmission of the other, probably through increased incidence of genital ulcers. Detection and treatment of syphilis can, therefore, help to reduce HIV transmission. Syphilis may present with non-typical features in the HIV-positive patient: there is a higher rate of symptomless primary syphilis and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurological and ophthalmic involvement. Diagnosis is generally made with serology but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen that is adequate for the treatment of neurosyphilis. Relapse of infection is more likely in the HIV-positive patient and careful follow-up is required.
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                Author and article information

                Contributors
                Beo Oliveira Leite: leitebeo@gmail.com
                Laio Magno: laiomagnoss@gmail.com
                Fabiane Soares: fabianesoares89@hotmail.com
                Sarah MacCarthy: smaccarthy@uab.edu
                Sandra Brignol: sandrabrignol@gmail.com
                Francisco Inácio Bastos: francisco.inacio.bastos@hotmail.com
                Inês Dourado: ines.dourado@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Public Health
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2458
                Publication date (Electronic): 18 November 2022
                Publication date PMC-release: 18 November 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 2120
                Affiliations
                [1 ]GRID grid.8399.b, ISNI 0000 0004 0372 8259, Collective Health Institute, Federal University of Bahia, ; Av. Basílio da Gama, s/n, Campus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
                [2 ]GRID grid.442053.4, ISNI 0000 0001 0420 1676, Life Sciences Department, Bahia State University, ; Campus1, Salvador, Bahia Brazil
                [3 ]GRID grid.265892.2, ISNI 0000000106344187, Department of Health Behavior, , Univeristy of Alabama, ; Birmingham, 1665 University Boulevard, Birmingham, AL 35209 USA
                [4 ]GRID grid.411173.1, ISNI 0000 0001 2184 6919, Fluminense Federal University, ; Rio de Janeiro, RJ Brazil
                [5 ]GRID grid.418068.3, ISNI 0000 0001 0723 0931, Oswaldo Cruz Foundation, ; Rio de Janeiro, RJ Brazil
                Article
                Publisher ID: 14589
                DOI: 10.1186/s12889-022-14589-5
                PMC ID: 9673344
                PubMed ID: 36401261
                SO-VID: ddbf411a-d64b-4572-b1f0-9eeb93ec8c40
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 18 August 2022
                Date accepted : 10 November 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Public health
                Keywords: hiv,transgender women,rds,brazil
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: hiv, transgender women, rds, brazil

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