Beatriz Grinsztejn1, Emilia M Jalil2, Laylla Monteiro2, Luciane Velasque3, Ronaldo I Moreira2, Ana Cristina F Garcia2, Cristiane V Castro2, Alícia Krüger4, Paula M Luz2, Albert Y Liu5, Willi McFarland6, Susan Buchbinder7, Valdilea G Veloso2, Erin C Wilson5. 1. Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Electronic address: gbeatriz@ini.fiocruz.br. 2. Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. 3. Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil. 4. Department of Surveillance, Prevention and Control of Sexually Transmitted Diseases, Aids and Viral Hepatitis, Brazilian Ministry of Health, Brazil. 5. Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA. 6. Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. 7. Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen in Rio de Janeiro and to identify predictors of newly diagnosed HIV infections. METHODS: We recruited transwomen from Rio de Janeiro, Brazil, by respondent-driven sampling. Eligibility criteria were self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or its metropolitan area, and having a valid peer recruitment coupon. We recruited 12 seed participants from social movements and formative focus groups who then used peer recruitment coupons to refer subsequent peers to the study. We categorised participants as HIV negative, known HIV infected, or newly diagnosed as HIV infected. We assessed predictors of newly diagnosed HIV infections by comparing newly diagnosed with HIV-negative participants. We derived population estimates with the Respondent-Driven Sampling II estimator. FINDINGS: Between Aug 1, 2015, and Jan 29, 2016, we enrolled 345 eligible transwomen. 29·1% (95% CI 23·2-35·4) of participants had no previous HIV testing (adjusted from 60 participants), 31·2% (18·8-43·6) had HIV infections (adjusted from 141 participants), and 7·0% (0·0-15·9) were newly diagnosed as HIV infected (adjusted from 40 participants). We diagnosed syphilis in 28·9% (18·0-39·8) of participants, rectal chlamydia in 14·6% (5·4-23·8), and gonorrhoea in 13·5% (3·2-23·8). Newly diagnosed HIV infections were associated with black race (odds ratio 22·8 [95% CI 2·9-178·9]; p=0·003), travesti (34·1 [5·8-200·2]; p=0·0001) or transsexual woman (41·3 [6·3-271·2]; p=0·0001) gender identity, history of sex work (30·7 [3·5-267·3]; p=0·002), and history of sniffing cocaine (4·4 [1·4-14·1]; p=0·01). INTERPRETATION: Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health-care and prevention services to curb the HIV epidemic and improve the quality of life of transwomen in Brazil. FUNDING: Brazilian Research Council, National Institute of Allergy and Infectious Diseases, Brazilian Sexually Transmitted Disease/AIDS, and Viral Hepatitis Department of the Brazilian Ministry of Health.
BACKGROUND: The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen in Rio de Janeiro and to identify predictors of newly diagnosed HIV infections. METHODS: We recruited transwomen from Rio de Janeiro, Brazil, by respondent-driven sampling. Eligibility criteria were self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or its metropolitan area, and having a valid peer recruitment coupon. We recruited 12 seed participants from social movements and formative focus groups who then used peer recruitment coupons to refer subsequent peers to the study. We categorised participants as HIV negative, known HIV infected, or newly diagnosed as HIV infected. We assessed predictors of newly diagnosed HIV infections by comparing newly diagnosed with HIV-negative participants. We derived population estimates with the Respondent-Driven Sampling II estimator. FINDINGS: Between Aug 1, 2015, and Jan 29, 2016, we enrolled 345 eligible transwomen. 29·1% (95% CI 23·2-35·4) of participants had no previous HIV testing (adjusted from 60 participants), 31·2% (18·8-43·6) had HIV infections (adjusted from 141 participants), and 7·0% (0·0-15·9) were newly diagnosed as HIV infected (adjusted from 40 participants). We diagnosed syphilis in 28·9% (18·0-39·8) of participants, rectal chlamydia in 14·6% (5·4-23·8), and gonorrhoea in 13·5% (3·2-23·8). Newly diagnosed HIV infections were associated with black race (odds ratio 22·8 [95% CI 2·9-178·9]; p=0·003), travesti (34·1 [5·8-200·2]; p=0·0001) or transsexual woman (41·3 [6·3-271·2]; p=0·0001) gender identity, history of sex work (30·7 [3·5-267·3]; p=0·002), and history of sniffing cocaine (4·4 [1·4-14·1]; p=0·01). INTERPRETATION: Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health-care and prevention services to curb the HIV epidemic and improve the quality of life of transwomen in Brazil. FUNDING: Brazilian Research Council, National Institute of Allergy and Infectious Diseases, Brazilian Sexually Transmitted Disease/AIDS, and Viral Hepatitis Department of the Brazilian Ministry of Health.
Authors: Alfonso Silva-Santisteban; H Fisher Raymond; Ximena Salazar; Jana Villayzan; Segundo Leon; Willi McFarland; Carlos F Caceres Journal: AIDS Behav Date: 2012-05
Authors: Nicky McCreesh; Simon D W Frost; Janet Seeley; Joseph Katongole; Matilda N Tarsh; Richard Ndunguse; Fatima Jichi; Natasha L Lunel; Dermot Maher; Lisa G Johnston; Pam Sonnenberg; Andrew J Copas; Richard J Hayes; Richard G White Journal: Epidemiology Date: 2012-01 Impact factor: 4.822
Authors: Karl L Dehne; Gina Dallabetta; David Wilson; Geoff P Garnett; Marie Laga; Elizabeth Benomar; Ade Fakoya; Rachel C Baggaley; Lisa J Nelson; Susan Kasedde; Alvaro Bermejo; Mitchell Warren; Clemens Benedikt Journal: Lancet HIV Date: 2016-07 Impact factor: 12.767
Authors: Segundo R Leon; Eddy R Segura; Kelika A Konda; Juan A Flores; Alfonso Silva-Santisteban; Jerome T Galea; Thomas J Coates; Jeffrey D Klausner; Carlos F Caceres Journal: BMJ Open Date: 2016-01-06 Impact factor: 2.692
Authors: Gabriel Alves de Sampaio Morais; Laio Magno; Andrea F Silva; Nathalia S Guimarães; José Alejandro Ordoñez; Luís Eugênio Souza; James Macinko; Inês Dourado; Davide Rasella Journal: Lancet HIV Date: 2022-10 Impact factor: 16.070
Authors: Sarah MacCarthy; Tonia Poteat; Zhiyu Xia; Nicolette L Roque; Ashley Hyun Jin Kim; Stefan Baral; Sari L Reisner Journal: Sex Health Date: 2017-10 Impact factor: 2.706
Authors: Emilia M Jalil; Beatriz Grinsztejn; Luciane Velasque; Alessandra Ramos Makkeda; Paula M Luz; Ronaldo I Moreira; Luciana Kamel; Nilo M Fernandes; Ana Cristina G Ferreira; Brenda Hoagland; Sandra Wagner; Albert Liu; Willi McFarland; Susan Buchbinder; Valdilea G Veloso; Erin Wilson Journal: J Acquir Immune Defic Syndr Date: 2018-12-01 Impact factor: 3.731
Authors: Jae Sevelius; Laura Rebecca Murray; Nilo Martinez Fernandes; Maria Amelia Veras; Beatriz Grinsztejn; Sheri A Lippman Journal: Cult Health Sex Date: 2018-10-31
Authors: Luca F Maschião; Francisco I Bastos; Erin Wilson; Willi McFarland; Caitlin Turner; Thiago Pestana; Maria Amélia Veras Journal: Transgend Health Date: 2020-12-11
Authors: Jesse Clark; Sari Reisner; Amaya Perez-Brumer; Leyla Huerta; Hugo Sanchez; Kathleen Moriarty; Maria Mamani Luque; Hideaki Okochi; Ximena Salazar; Matthew Mimiaga; Jorge Sanchez; Monica Gandhi; Kenneth H Mayer; Javier R Lama Journal: AIDS Behav Date: 2021-01-01