HIV continuum of care among trans women and <i>travestis</i> living in São Paulo, Brazil

Rocha, Aline Borges Moreira da; Barros, Cláudia; Generoso, Igor Prado; Bastos, Francisco I.; Veras, Maria Amélia

doi:10.11606/s1518-8787.2020054002374

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002374 copy

HIV continuum of care among trans women and travestis living in São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

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.

DESCRIPTORS:
Transgender Persons; Transvestism; HIV Infections, prevention & control; HIV Seroprevalence; Anti-Retroviral Agents, therapeutic use; Health Services Accessibility

Variable		% ^* * Weighted proportion using RDS complex sampling procedures.	95%CI
Gender
	Woman	9.32	5.93–14.37
	Trans woman	39.95	32.95–47.73
	Travesti	50.5	42.94–58.03
Skin color
	White	30.02	23.38–37.61
	Black	15.91	11.43–21.71
	Mixed	50.55	42.99–58.09
	Other (Indigenous/Yellow)	3.53	1.77–6.89
Education
	More than high school	12.04	7.63–18.47
	High school	40.41	33.17–48.09
	Less than high school	47.55	40.09–55.13
Income (minimum wage - MW)
	More than three MW	14.74	10.06–21.09
	Between one and three MW	48.95	41.43–56.53
	Less than one MW	36.31	29.52–43.68
Age
	< 24	23.62	17.82–30.61
	25–30	32.39	25.65–39.95
	31–40	29.05	22.61–36.47
	> 40	14.94	10.47–20.86
Housing situation
	Stable	69.61	62.56–75.85
	Unstable	30.39	24.15–37.44
Relationship status
	Single	62.82	55.08–69.95
	Dating	14.63	9.86–21.17
	Married	21.62	15.82–28.82
	Other	0.93	0.29–2.96
Registered in health care service
	No	19.51	13.87–26.72
	Yes	80.49	73.28–86.13

Variable		HIV diagnosed		p	ART prescription		p	Currently taking ART		p
Variable		% ^* * Weighted proportion using RDS complex sampling procedures. Bolded values: Statistically significance.	95%CI	p	% ^* * Weighted proportion using RDS complex sampling procedures. Bolded values: Statistically significance.	95%CI	p	% ^* * Weighted proportion using RDS complex sampling procedures. Bolded values: Statistically significance.	95%CI	p
Gender				0.382			0.675			0.393
	Woman	59.0	20.6–88.9		86.1	50.3–97.4		76.8	30.4–96.2
	Trans woman	86.4	60.6–96.3		72.3	47.2–88.5		94.5	76.4–98.9
	Travesti	80.6	60.9–91.8		79.4	58.3–91.4		89.8	76.8–95.9
Skin color				0.697			0.691			0.134
	White	75.8	43.5–92.8		84.6	43.5–97.5		94.7	79.4–98.8
	Black	89.0	63.8–97.4		72.3	43.6–89.8		100	-
	Mixed	81.1	62.7–91.7		73.5	52.9–87.3		89.0	75.6–95.5
	Other (Indigenous/Yellow)	90.8	62.8–98.3		100	-		56.5	11.9–92.5
Education				0.968			0.745			0.694
	More than high school	76.9	27.7–96.6		69.9	20.9–95.3		87.5	43.4–98.5
	High school	81.3	54.5–94.0		83.3	56.2–95.1		94.2	79.6–98.6
	Less than high school	81.5	63.3–91.9		73.5	52.8–87.3		88.8	74.4–95.5
Income (minimum wage - MW)				0.061			0.394			0.082
	More than three MW	50.8	21.4–79.8		95.8	85.4–98.9		100	-
	Between one and three MW	82.7	58.5–94.3		74.7	49.2–90.1		96.9	86.5–99.4
	Less than one MW	89.0	69.7–96.6		74.7	52.7–88.7		83.3	66.8–92.6
Age				0.098			0.159			0.002
	< 24	69.5	38.5–89.3		75.9	48.2–91.5		64.6	33.4–86.9
	25–30	74.3	48.3–89.9		71.6	43.1–89.4		93.4	75.8–98.8
	31–40	89.8	74.7–96.3		62.1	30.9–85.7		99.0	92.7–99.8
	> 40	98.5	89.3–89.8		100	-		100	-
Housing situation				0.871			0.760			0.260
	Stable	79.9	60.9–91.1		74.8	53.1–88.7		93.8	83.4–97.8
	Unstable	81.8	58.7–93.5		78.8	56.4–91.5		86.6	68.9–94.9
Relationship status				0.932			0.680			0.474
	Single	80.6	61.9–91.4		80.0	62.4–90.7		93.8	84.4–97.7
	Dating	77.6	41.6–94.4		80.2	33.6–97.0		89.9	62.2–97.9
	Married	83.6	48.6–96.5		64.9	31.1–88.4		82.5	49.9–95.7
	Other	100	-		84.2	32.4–98.3		87.5	36.1–98.8
Registred in health care service				0.003			0.255			< 0.001
	No	45.1	17.5–76.0		55.3	16.6–88.5		43.4	13.8–78.5
	Yes	88.2	75.2–94.8		78.9	63.3–89.0		94.3	85.9–97.8

Variable		Have ART prescription				Currently take ART
Variable		PRR	95%CI	aPRR	95%CI	PRR	95%CI	aPRR	95%CI
Gender
	Woman	Reference	-	Reference	-	Reference	-	Reference	-
	Trans woman	0.84	0.56–1.24	0.56	0.31–0.98	1.23	0.76–1.98	1.16	0.90–1.49
	Travesti	0.92	0.66–1.27	0.64	0.37–1.11	1.16	0.72–1.88	1.15	0.90–1.47
Skin color
	White	Reference	-	Reference	-	Reference	-	Reference	-
	Black	0.85	0.54–1.34	0.73	0.51–1.05	1.05	0.97–1.14	0.99	0.86–1.14
	Mixed	0.86	0.59–1.27	0.89	0.68–1.15	0.93	0.82–1.07	0.97	0.85–1.11
	Other (Indigenous/ Yellow)	1.18	0.87–1.59	1.50	0.91–2.45	0.59	0.22–1.59	0.98	0.51–1.87
Education
	More than High School	Reference	-	Reference	-	Reference	-	Reference	-
	High School	1.19	0.59–2.37	1.00	0.66–1.54	1.07	0.80–1.43	1.12	0.86–1.47
	Less than High School	1.05	0.52–2.10	0.79	0.51–1.24	1.01	0.75–1.36	1.02	0.75–1.39
Income (minimum wage - MW)
	More than three MW	Reference	-	Reference	-	Reference	-	Reference	-
	Between one and three MW	0.78	0.58–1.04	0.78	0.58–1.04	0.96	0.92–1.01	0.96	0.81–1.14
	Less than one MW	0.77	0.60–1.00	0.66	0.43–1.03	0.83	0.71–0.97	0.81	0.67–0.98
Age
	< 24	Reference	-	Reference	-	Reference	-	Reference	-
	25–30	0.94	0.60–1.47	0.96	0.62–1.48	1.44	0.90–2.30	1.34	0.92–1.94
	31–40	0.81	0.46–1.44	0.81	0.48–1.37	1.53	0.96–2.42	1.65	1.09–2.50
	> 40	1.31	0.98–1.76	1.56	1.06–2.30	1.54	0.97–2.44	1.59	1.04–2.43
Housing situation
	Stable	Reference	-	Reference	-	Reference	-	Reference	-
	Unstable	1.05	0.76 −1.46	1.17	0.82–1.66	0.92	0.78–1.08	1.03	0.91–1.17
Relationship status
	Single	Reference	-	Reference	-	Reference	-	Reference	-
	Dating	1.00	0.64–1.56	1.11	0.64–1.93	0.95	0.79–1.14	1.05	0.82–1.35
	Married	0.81	0.47–1.37	0.96	0.67–1.38	0.87	0.66–1.16	0.85	0.70–1.03
	Other	1.05	0.69–1.59	1.22	0.62–2.40	0.93	0.67–1.28	0.82	0.57–1.16
Registred in health care service
	No	Reference	-	Reference	-	Reference	-	Reference	-
	Yes	1.42	0.62–3.27	1.63	0.83–3.17	2.17	0.89–5.28	2.06	1.09–3.88

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[1] Correspondence: Maria Amélia Veras Rua Dr. Cesário Mota Jr., 61 01221-020 São Paulo Brasil. E-mail: maria.veras@gmail.com