Abstract
ABSTRACTOBJECTIVE: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.
Highlights
Among the different populations at high risk of HIV infection, people who identify as transgender women and travestis have one of the highest HIV infection rates around the world[1]
Our data suggest an increase in the testing and treatment policy implementation among trans women in the city of São Paulo, gaps have been found in the linkage to care
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
Summary
Among the different populations at high risk of HIV infection, people who identify as transgender women and travestis have one of the highest HIV infection rates around the world[1]. A study conducted in 2016 with transgender women in Rio de Janeiro identified a difference between the reported and confirmed HIV prevalence (24.2% and 31.2%, respectively), suggesting that a part of the population did not know their serological status, or did not have access to prior HIV testing before participating in the study[6]. The prevalence of HIV infection in transgender women is not documented in a systematic way by health services, neither by most surveillance systems (which frequently do not report the category “transgender”), resulting in a lack of information about the epidemic. Gathering specific epidemiological data about trans women and travestis can help identify the magnitude of this epidemic, its trends, and allow for the collaboration with executive health plans and reformulation of properly tailored public policies[7,8]
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