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James Jones
James Jones

Shemales With Hiv [NEW]

"Some men used condoms... some didn't. Sometimes the condom broke," she says without rancour of her time turning tricks in Pattaya -- one of the centres of Thailand's flourishing sex industry and home to 3,000 transgenders in tourist season.

shemales with hiv

Soft spoken and slight with a dusting of make-up over her wan face, Gigi cuts an image far from the caricature of the bawdy "Katoey", as Thailand's estimated 180,000 transgenders -- or "ladyboys" -- are known.

Chaotic lifestyles compound the challenges of HIV diagnosis and treatment, he explains, with many among the community focused on making money to support themselves or undergo expensive hormone treatment and sex-change surgery.

Infection rates are intertwined with the wider issue of discrimination, according to transgender researcher and activist Prempreeda Pramoj Na Ayutthaya, who says health services, education and job opportunities routinely fail to reach the community.

One solution is to direct resources specifically at transgenders in an effort to diagnose and treat those with HIV, prevent new infections and build a more detailed picture of how the illness is hitting the community.

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.

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.

Such inequities regarding HIV can be explained by contexts of vulnerability that contribute to increased risk for HIV: structural venerability includes poor socioeconomic conditions (e.g., when gender identity represents a barrier to ensuring stable employment) and difficult access to prevention and care services of HIV and other STIs (e.g. discrimination in health services by health professionals and lack of qualified care) [11,12,13,14,15]; interpersonal vulnerability, such as discrimination and violence driven by gender identity (e.g., transphobia) within social interactions creates further vulnerability to HIV [11, 16,17,18,19]; Finally, individual vulnerability includes sexual behaviors and practices (e.g., more money offered for higher risk sexual acts such as unprotected sex, condomless anal sex, number of partners or illicit substances use) [3, 11, 18, 20,21,22,23].

[3]. Thus, the aim of this study is to estimate the prevalence of HIV infection among TGW, and to analyze the factors associated with HIV prevalence in two surveys carried out in Salvador, Northeast Brazil.

The study analyzes data from two cross-sectional survey with TGW, conducted between September 2014 and April 2016 (PopTrans study) [24, 25], and October 2016 and July 2017 (DIVAS study) [26], respectively. Both studies were carried out in Salvador, the capital of the state of Bahia, which is the fourth largest city in Brazil, the 12th position in the gross domestic product ranking of Brazilian municipalities and has an index of income distribution across a population of 49.0% (46.0-52.0%). The population is mostly composed of Afro-descendant Brazilians (83.1%) [27, 28].

Data were collected through interviews with a standardized pre-tested questionnaire, conducted face-to-face by interviewers in a space reserved exclusively for this purpose. In both studies, rapid antigen tests for HIV and syphilis were used according to the Brazilian Ministry of Health standards of care for HIV.

The main outcome considered for both studies was HIV infection. All participants received pre- and post-test counseling and guidance before and after receiving the results of their tests. A whole blood rapid test by finger prick was performed. If this rapid test was reactive, a second confirmatory one of a different brand was performed, following the HIV testing algorithm of the Brazilian Ministry of Health [35]. Cases in which the first HIV rapid test was reactive and the second non-reactive or indeterminate, or the first was indeterminate, were considered as inconclusive results and excluded from the analysis [36]. In addition, whole blood rapid test was performed by finger prick for syphilis. Individuals with the first non-reactive test were classified in this study as uninfected. Individuals with both screening and confirmatory tests positive were classified as infected. All participants considered to have a positive rapid test result were referred to public health services for confirmatory tests, monitoring and treatment of the infection. For both studies the HIV and syphilis detection methodologies and procedures were similar and therefore comparable.

This study indicated a high prevalence of HIV in PopTrans (9.0%), and even higher in DIVAS (24.3%) among TGW in the city of Salvador, when compared to the general female population of Brazil (0.4%) [10]. Other studies with TGW conducted in Latin America show even higher prevalence rates. In Argentina, a survey identified that 34.1% (95%CI:28.7-39.9) of TGW were infected with HIV [41]. In Uruguay, Russi et al. [42] reported an HIV prevalence as high (21.5%) among TGW. Corroborating the aforementioned estimates, a meta-analytic study estimated a pooled HIV prevalence in Argentina and Uruguay of 33.5 and 18.8%, respectively [3].

The prevalence differences found in both the PopTrans and DIVAS studies have no a simple explanation. Both studies were performed in same city, with same methods, and both studies may have used similar samples, but we cannot guarantee that they are exactly the same individuals. However, two hypotheses should be considered: the natural increase in the prevalence of infectious diseases that have no cure [43], and a non-probabilistic sample which may bias an external validity [44]. Significant progress has yet to be fully achieved as methods incorporating transportability have been progressively refined and applied to different populations in recent publications [45]. The same reasoning applies to our studies whereby small sample sizes are combined with larger geographical areas than Salvador, Bahia.

This study shows that gender-based discrimination increased the chance of HIV infection. This form of discrimination can be defined by moral, physical or psychological violence faced by TGW as a consequence of patriarchal and sexist societies [11, 46, 47]. Thus, discrimination is reported as a structural factor that exacerbates vulnerability of TGW to HIV, such as preventing access to health services promoting HIV prevention and care [11, 48, 49]. In the peer-reviewed literature, discrimination is also reported as a factor influencing vulnerability to HIV through association with risk behaviors, such as exposure to condomless anal sex which can hinder the negotiation of safe practices during receptive anal sex or access to condom [50,51,52,53].

The literature has pointed to sexual assault by family members [54, 55], as well as physical and sexual abuse, as factors associated with HIV infection among TGW [56]. Studies have also reported different forms of violence perpetrated by neighbors [55] and family [54, 55]. These experiences of abuse and discrimination has been shown to impact TGW across their life cousre and ofen starts within the family through rejection [19, 55, 57,58,59,60,61,62,63,64,65,66,67,68,69] and expulsion from home [60, 62, 64, 67] causing some TGW to be unstably housed [64, 66] and cause intense geographical displacement [70] and entry into sex work [15, 19, 50, 58, 61, 62, 64, 67, 70,71,72], a risk factor also highlighted in our study.

This study has some limitations. Our study (like all other RDS studies) uses non-probability samples and invariably recruit a small number of participants. Non-probability samples are always associated with challenges to statistical inference [79]. Small samples are never free of potential beta type errors or, as recently proposed, by Rothman and Greenland [80] lack the so desired precision (as made evident by large confidence intervals). On the other hand, local studies are an invaluable source of information for pooled analyses. The latter have been found to be accurate and a key asset for public policies as mentioned.

Finally, selection bias may be an issue, as the seeds invited their peers in a chain [34]. However, the adjustment used by RDS reduces this bias and makes it possible to generate important information about the network. As is common with populations that are difficult to access, several other studies have used the RDS design for these populations as the most feasible option [7, 12, 16, 83,84,85].

The prevalence of HIV infection among TGW remains high. Even as Brazilian policies on HIV/AIDS and other STI have progressed over the years, these data indicate the urgency of intersectoral actions on the determinants of vulnerability to HIV/AIDS. Further it underscores the need for health interventions to develop TGW-specific prevention, treatment and other health services or programs, especially with regard to addressing gender-based discrimination in general, and specifically among family and neighbors. Gender-based discrimination has been increasingly reported as a key factor severely limiting access to existing health services and programs among TGW and other gender discordant population. Our study reinforces the need to implement policies that combat discrimination in general and specifically in the context of health services and programs. Only in so doing can we curb new infections and simultaneously address the broader context of social vulnerability that permeates the daily experience of TGW in Brazil and beyond. 041b061a72


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