Abstract
BackgroundGender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil.MethodsThis is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months.Results547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14–0·63) and HIV testing (OR: 0·41; 95%CI: 0·22–0·78) in the last 12 months.ConclusionGender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.
Highlights
Gender-based discrimination remains a substantial barrier to health care access and Human Immunodeficiency Virus (HIV) prevention among transgender women in Brazil
Our study found that genderbased discrimination (GBD) was responsible for reducing 71% of medical visits and 59% of HIV testing in the last year, regardless of the other social markers studied in this population
The study showed that the prevalence of medical visits in the last 12 months did not match the expected number and respective proportions of HIV testing in the last 12 months among Transgender women (TGW), which points to the loss of HIV testing opportunities since this is a population in a context of high vulnerability and risk of HIV infection
Summary
Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. Leite et al Int J Equity Health (2021) 20:199 ensure people living with HIV should know their status, start antiretroviral treatment, and being treated should achieve viral suppression, is the implementation of strategies to assure competent health services to approach and care key populations [3, 4]. The focus is to create the individual’s bond with the health service, monitor, promote health education, and treat HIV and other sexually transmitted infections (STI) [5]. These services are not always available or accessible to everyone. TGW have limited access to health services, which include a lower frequency of HIV testing, HIV prevention, and health care in general [6]
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