Abstract
IntroductionTransgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America.MethodsWe conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations.Results and discussionOverall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws.ConclusionsTransgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.
Highlights
Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%
Studies carried out using the modes of transmission model in nine Latin American countries show that new infections among transgender women may account for 1 to 10% of all new infections and that the transmission rate can be higher than that of men who have sex with men (MSM) in some countries [2,3]
Informants were requested to 1) identify the main HIV prevention strategies for transgender women implemented in countries; 2) recommend programmatic documents, evaluations or other working documents that should be included in the review; and 3) identify strategies and interventions that could be considered best practices to improve HIV prevention among transgender women
Summary
Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. This vulnerability is a result of the complex interaction of risks at the individual level (e.g. condomless receptive anal sex as a common sexual practice, substance use, high number of partners with sex work as their main economic activity), interpersonal risks (e.g. poor condom negotiation skills with partners and clients, high-risk partner pool) and structural factors (e.g. social exclusion, violence, discrimination, few employment options, lack of legal recognition of gender identity) [4Á8]. This complexity demands a multisectoral and multidisciplinary response to the epidemic
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