Association between in-country migration and HIV infection among transgender women from northeastern Brazil: a respondent-driven sampling survey.

BACKGROUND: Migration is common among transgender women (TGW), often driven by the desire to escape stigma, find acceptance, establish new connections, access body modifications, or enter new avenues of sex work. Given the heightened mobility of TGW, they are mostly vulnerable to human immunodeficiency virus (HIV) due to migration. This study aimed to evaluate the association between in-country migration and HIV infection among TGW in Northeast Brazil. METHODS: The DIVAS was a cross-sectional, multicity study investigating risk behaviors and sexually transmitted infections (STI) among TGW in 2016-2017. A total of 864 TGW were recruited through respondent-driven sampling from three capital cities in Northeast Brazil. Logistic regression estimating odds ratios (OR) and 95% confidence intervals (CI) was used to assess the relationship between in-country migration and HIV infection. RESULTS: The prevalence of HIV among TGW was 24.5%, 21.4% among those aged 18-34 and 36.1% among those ≥ 35 years old. In-country migration increased the odds of HIV infection among TGW aged 18-34 years (OR = 1.84; 95%CI:1.04-3.27) and even higher among those aged ≥ 35y old (OR = 3.08; 95%CI:1.18-8.04). CONCLUSIONS: These data reinforce the pressing need for public health policies that provide comprehensive access and strategies for demand creation for HIV/AIDS prevention and care for TGW who are already highly vulnerable to infection.

Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study).

PURPOSE: To evaluate the adherence, safety, and feasibility of pre-exposure prophylaxis (PrEP) in real-world settings among adolescent men who have sex with men (AMSM) and transgender women (ATGW). METHODS: PrEP1519 is a single-arm, multicentric demonstration cohort study of daily oral PrEP among AMSM and ATGW aged 15 to 19 years in Brazil. Study visits occurred at baseline, weeks 4, 12, and then quarterly until 96 weeks. Descriptive statistics and a mixed logistic model for longitudinal data evaluated the factors associated with high adherence. RESULTS: One thousand sixteen AMSM and ATGW accessed the PrEP1519 clinics. Of those, 998 (98.2%) underwent clinical triage. Forty one were diagnosed with human immunodeficiency viruses (HIV) at baseline (4.0%) and 79 (7.9%) were not eligible for PrEP. Of the 878, 795 (90.5%) enrolled in PrEP, 82 (10.3%) were lost to follow-up, and 713 were included. There was no significant decrease in creatinine clearance; only two participants had grade-III aspartate aminotransferase elevation. Incident HIV infection occurred in eight participants (incidence rate [IR] = 1.64 per 100 person-years [PY]): two in 15-17 years (IR = 2.24 per 100 PY) and six in 18-20 years (IR = 1.51 per 100 PY). PrEP adherence was higher among those with more years of schooling, those reporting no difficulties in PrEP use due to side effects, and who had low HIV risk perception in the past three months. DISCUSSION: PrEP for AMSM and ATGW was safe and feasible in real-world settings. However, a higher IR among young adolescents and a higher adherence among less vulnerable people indicate the need for greater care, considering the specificities of this age group.

HIV prevalence among transgender women in Northeast Brazil - Findings from two Respondent Driven Sampling studies.

BACKGROUND: 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. METHODS: The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression. RESULTS: 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. CONCLUSION: We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.

Medication use among quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil. / Uso de medicamentos entre adolescentes rurais quilombolas e não quilombolas no interior da Bahia, Brasil.

This study aims to describe the use of prescribed and non-prescribed medications and associated factors among adolescents living in rural, quilombolas and non-quilombolas communities in the interior of Bahia, Brazil. This is a population-based survey with 390 adolescents between 10 and 19 years old in 2015. Prevalence and odds ratio for use of prescribed and non-prescribed medication, and multiple analysis was conducted by Multinomial Logistic Regression. Among the interviewees, 13.6% used only prescribed medications and 14.4% only used non-prescribed medications. Quilombolas demonstrated a greater diversity of pharmaceutical specialties used. The low prevalence of medication use in both groups of adolescents suggests less access to these products. Despite this, it was observed the irrational use of medication, mainly as self-medication. Quilombola adolescents, although they belong to the same area of coverage of other communities, presented different associated factors when compared to the non-quilombola group: the presence of toothache in the last 6 months and have had a regular source of care increased the use of prescribed medications.

Este estudo visa descrever o uso de medicamentos prescritos e não prescritos e fatores associados entre adolescentes residentes em comunidades rurais, quilombolas e não quilombolas, do interior da Bahia, Brasil. Trata-se de um inquérito populacional com 390 adolescentes entre 10 e 19 anos de idade, realizado em 2015. Foram estimadas prevalências e odds ratio para uso de medicamentos prescritos e não prescritos, e análise múltipla foi conduzida por Regressão Logística Multinomial. Entre os entrevistados, 13,6% fez uso apenas de medicamentos prescritos e 14,4% fez uso apenas de medicamentos não prescritos. Os quilombolas demonstraram uma maior diversidade de especialidades farmacêuticas utilizadas. A baixa prevalência no uso de medicamentos nos dois grupos de adolescentes sugere um menor acesso a esses produtos. Apesar disso, observou-se a utilização irracional de medicamentos, principalmente como automedicação. Os adolescentes quilombolas, mesmo dentro da área de abrangência das outras comunidades, apresentaram diferentes fatores associados quando comparado ao grupo não quilombola: a presença de dor de dente nos últimos 6 meses e procurar o mesmo serviço de saúde aumentaram o uso de medicamentos prescritos.

Uso de medicamentos entre adolescentes rurais quilombolas e não quilombolas no interior da Bahia, Brasil / Medication use among quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil

Resumo Este estudo visa descrever o uso de medicamentos prescritos e não prescritos e fatores associados entre adolescentes residentes em comunidades rurais, quilombolas e não quilombolas, do interior da Bahia, Brasil. Trata-se de um inquérito populacional com 390 adolescentes entre 10 e 19 anos de idade, realizado em 2015. Foram estimadas prevalências e odds ratio para uso de medicamentos prescritos e não prescritos, e análise múltipla foi conduzida por Regressão Logística Multinomial. Entre os entrevistados, 13,6% fez uso apenas de medicamentos prescritos e 14,4% fez uso apenas de medicamentos não prescritos. Os quilombolas demonstraram uma maior diversidade de especialidades farmacêuticas utilizadas. A baixa prevalência no uso de medicamentos nos dois grupos de adolescentes sugere um menor acesso a esses produtos. Apesar disso, observou-se a utilização irracional de medicamentos, principalmente como automedicação. Os adolescentes quilombolas, mesmo dentro da área de abrangência das outras comunidades, apresentaram diferentes fatores associados quando comparado ao grupo não quilombola: a presença de dor de dente nos últimos 6 meses e procurar o mesmo serviço de saúde aumentaram o uso de medicamentos prescritos.

Abstract This study aims to describe the use of prescribed and non-prescribed medications and associated factors among adolescents living in rural, quilombolas and non-quilombolas communities in the interior of Bahia, Brazil. This is a population-based survey with 390 adolescents between 10 and 19 years old in 2015. Prevalence and odds ratio for use of prescribed and non-prescribed medication, and multiple analysis was conducted by Multinomial Logistic Regression. Among the interviewees, 13.6% used only prescribed medications and 14.4% only used non-prescribed medications. Quilombolas demonstrated a greater diversity of pharmaceutical specialties used. The low prevalence of medication use in both groups of adolescents suggests less access to these products. Despite this, it was observed the irrational use of medication, mainly as self-medication. Quilombola adolescents, although they belong to the same area of coverage of other communities, presented different associated factors when compared to the non-quilombola group: the presence of toothache in the last 6 months and have had a regular source of care increased the use of prescribed medications.

Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil.

BACKGROUND: Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil. METHODS: This is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months. RESULTS: 547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14-0·63) and HIV testing (OR: 0·41; 95%CI: 0·22-0·78) in the last 12 months. CONCLUSION: Gender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.