Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas.

INTRODUCTION: Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS: We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER: NCT03081559.

Impairments and related social inequalities among adults: a population-based study in São Paulo city, Brazil.

The study of the association of social variables with the prevalence of impairments can provide subsidies for more adequate care and health policies for the most needy people by incorporating social aspects. This article aims to estimate the prevalence of diverse types of impairments, the degree of difficulty, limitations, and the need for help they cause and attest whether this prevalence differ by educational attainment in individuals aged 20 years or older. This is a populational cross-sectional study (2015 Health Survey of São Paulo-ISA Capital). Data from 3184 individuals were analyzed via educational attainment as exposure variable and outcome variables related to visual, hearing, intellectual, and mobility impairments. 19.9% of participants had visual, 7.8%, hearing, 2.7%, intellectual, and 7.4%, mobility impairments. Mobility and intellectual impairments limited participants' daily activities the most, 70.3% and 63.3%, respectively; who, thus, needed the most help: 48.9% and 48.5%, respectively. Lower schooling was associated with a higher prevalence of impairments, greater need for help due to visual and intellectual impairments, and greater limitations due to hearing and visual impairments.

Acceptability and Usability of Self-Sampling for the Detection of Sexually Transmitted Infections Among Transgender Women: The TransOdara Multicentric Study in Brazil.

BACKGROUND: The effective testing of sexually transmitted infections (STIs) requires sampling from potential infection sites. This study aimed to assess the choice, satisfaction, and performance of self-collected samples (SCS) from potential infection sites for STI testing among transgender women in Brazil. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study conducted in 5 Brazilian cities. Using respondent-driven sampling, 1317 transgender women 18 years or older were recruited. Participants completed interviewer-led questionnaires and provided swab samples from multiple sites (anorectal, oropharyngeal, genital) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and human papillomavirus (HPV) testing. Participants were given a choice of SCS or provider-collected samples (PCS) at each site. RESULTS: Most participants selected SCS for anorectal (74.9%; 95% confidence interval [CI], 72.4-77.3) and genital (72.7%; 95% CI, 70.2-75.1) sites, whereas fewer chose for oropharyngeal samples (49.8%; 95% CI, 47.0-52.6). For future testing, most participants expressed a preference for SCS for genital (72.2%; 95% CI, 69.5-74.7) and anorectal (70.2%; 95% CI, 67.6-72.7) sites. There was no significant difference in the positive test results for CT and NG between SCS and PCS at anorectal and oropharyngeal sites, or for HPV at anorectal and genital (penile or neovaginal) sites. CONCLUSIONS: This study demonstrated a high level of acceptability and usability of self-sampling for STI testing among transgender women. A preference for SCS was evident at the anorectal and genital sites, and the results of SCS were comparable to those of PCS. The findings suggest that multisite STI testing utilizing self-collection methods as a provided option can be effectively integrated into sexual health services for transgender women.

Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil.

BACKGROUND: Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS: A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS: A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION: Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03525340.

Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches.

OBJECTIVES: We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS: Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS: High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.

Impairments and related social inequalities among adults: a population-based study in São Paulo city, Brazil / Deficiências e desigualdades sociais entre adultos: um estudo de base populacional na cidade de São Paulo, Brasil

Abstract The study of the association of social variables with the prevalence of impairments can provide subsidies for more adequate care and health policies for the most needy people by incorporating social aspects. This article aims to estimate the prevalence of diverse types of impairments, the degree of difficulty, limitations, and the need for help they cause and attest whether this prevalence differ by educational attainment in individuals aged 20 years or older. This is a populational cross-sectional study (2015 Health Survey of São Paulo-ISA Capital). Data from 3184 individuals were analyzed via educational attainment as exposure variable and outcome variables related to visual, hearing, intellectual, and mobility impairments. 19.9% of participants had visual, 7.8%, hearing, 2.7%, intellectual, and 7.4%, mobility impairments. Mobility and intellectual impairments limited participants' daily activities the most, 70.3% and 63.3%, respectively; who, thus, needed the most help: 48.9% and 48.5%, respectively. Lower schooling was associated with a higher prevalence of impairments, greater need for help due to visual and intellectual impairments, and greater limitations due to hearing and visual impairments.

Resumo O estudo da associação de variáveis ​​sociais com a prevalência de deficiências pode fornecer subsídios para uma atenção e políticas de saúde mais adequadas às pessoas mais carentes ao incorporar aspectos sociais. O objetivo deste artigo é estimar a prevalência de diversos tipos de deficiências, o grau de dificuldade, as limitações e a necessidade de ajuda e verificar se essa prevalência difere por escolaridade em indivíduos com 20 anos ou mais. Trata-se de um estudo transversal populacional (Inquérito de Saúde de São Paulo 2015 - ISA-Capital). Os dados de 3.184 indivíduos foram analisados ​​com a escolaridade como variável de exposição relacionada às deficiências visuais, auditivas, intelectuais e de mobilidade. Dezenove vírgula nove por cento dos participantes apresentavam deficiência visual, 7,8% auditiva, 2,7% intelectual e 7,4% de mobilidade. Mobilidade e deficiência intelectual foram as que mais limitaram as atividades diárias, 70,3% e 63,3%, respectivamente, sendo, portanto, as que mais necessitaram de ajuda: 48,9% e 48,5%, respectivamente. Menor nível de escolaridade mostrou associação com maior prevalência de deficiências, maior necessidade de ajuda por deficiência visual e intelectual e maiores limitações por deficiência auditiva e visual.

Prevalence of syphilis in transgender women and travestis in Brazil: results from a national cross-sectional study / Prevalência de sífilis em mulheres trans e travestis no Brasil: resultados de um estudo multicêntrico nacional

ABSTRACT Objective: The study aimed to estimate the prevalence of acquired syphilis and associated factors in a national survey. Methods: TransOdara was a cross-sectional study comprising transgender women and travestis (TGW) in five major cities in Brazil during December of 2019 and July of 2021. The sample was recruited using the respondent-driven sampling (RDS) method. The outcome "active syphilis" was defined as a positive treponemal test and Venereal-Disease-Research-Laboratory (VDRL) title greater than∕ equal to ⅛. Sociodemographic variables were described. Bivariate and multiple logistic regression were performed, and odds ratios (OR) and 95% confidence intervals (95%CI) were estimated. All analyses were performed in R, 4.3.1. Results: A total of 1,317 TGW were recruited, with 1,291 being tested for syphilis, and 294 (22.8%) meeting the criteria for active syphilis. In bivariate analysis, black/mixed race (OR=1.41, 95%CI 1.01-1.97), basic level of education (OR=2.44, 95%CI 1.17-5.06), no name change in documents (OR=1.39, 95%CI 1.00-1.91) and sex work (past only OR= 2.22, 95%CI 1.47-3.32; partial OR=2.75, 95%CI 1.78-4.25; full time OR=3.62, 95%CI 2.36-5.53) were associated with active syphilis. In the multivariate analysis, sex work was the only associated factor, 2.07 (95%CI 1.37-3.13) past sex work, 2.59 (95%CI 1.66-4.05) part-time sex work and 3.16 (95%CI 2.04-4.92) sex work as the main source of income. Conclusion: The prevalence of active syphilis in this study was elevated compared with other countries in Latin America. Sex work was an important associated factor with active syphilis, highlighting the impact that this condition of vulnerability may have in the health of TGW, as members of a key, marginalized population.

RESUMO Objetivo: O estudo teve como objetivo estimar a prevalência de sífilis adquirida e fatores associados em uma pesquisa nacional. Métodos: "TransOdara" foi um estudo transversal compreendendo mulheres trans e travestis (MTT) em cinco grandes cidades do Brasil durante dezembro-2019 e julho-2021. A amostra foi recrutada usando o método respondente-driven sampling (RDS). O desfecho "sífilis ativa" foi definido como um teste treponêmico positivo e título do Venereal-Disease-Research-Laboratory (VDRL) maior ou igual a ⅛. Variáveis sociodemográficas foram descritas. Análises bi- e multivariadas foram realizadas, e odds ratio (OR) e IC95% foram estimados. Todas as análises foram realizadas no R,4.3.1. Resultados: Um total de 1.317 MTT foram recrutadas, com 1.291 sendo testadas para sífilis, das quais 294 (22,8%) preencheram os critérios para sífilis ativa. Na análise bivariada, raça negra/parda (OR=1,41; IC95% 1,01-1,97), nível básico de educação (OR=2,44; IC95% 1,17-5,06), não alteração do nome nos documentos (OR=1,39; IC95% 1,00-1,91) e trabalho sexual (pregresso OR=2,22; IC95% 1,47-3,32; parcial OR=2,75; IC95% 1,78-4,25; período integral OR=3,62; IC95%: 2,36-5,53) foram associados à sífilis ativa. Na análise multivariada, o trabalho sexual foi o único fator associado, 2,07 (IC95%: 1,37-3,13) trabalho sexual passado, 2,59 (IC95% 1,66-4,05) trabalho sexual em tempo parcial e 3,16 (IC95% 2,04-4,92) trabalho sexual como principal fonte de renda. Conclusão: A prevalência de sífilis ativa neste estudo foi elevada em comparação com outros países da América Latina. O trabalho sexual foi um fator associado importante com sífilis ativa, destacando o impacto que essa condição de vulnerabilidade pode ter na saúde das MTT, como membros de uma população-chave marginalizada.

TransOdara study: the challenge of integrating methods, settings and procedures during the COVID-19 pandemic in Brazil / Estudo TransOdara: o desafio de integrar métodos, contextos e procedimentos durante a pandemia de COVID-19 no Brasil

ABSTRACT Objective Sexually transmitted infections (STIs) disproportionately affect transgender women and travestis (TGW), who often lack access to healthcare due to stigma and discrimination. We describe the approach and methodology of a study investigating the prevalence of syphilis, HIV, hepatitis A, B, and C, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and human papillomavirus (HPV) among TGW, as well as their knowledge and perceptions regarding syphilis, to better inform policies to curb STIs among this vulnerable population. Methods: TransOdara was a multicentric, cross-sectional study conducted among TGW in five capital cities from major Brazilian regions between December 2019 and July 2021. Self-identified transgender women and travestis aged >18 years were recruited using respondent-driven sampling after a qualitative formative phase, completed an interviewer-led questionnaire, were offered a physical examination, and were also asked to provide samples from multiple sites to detect various STIs, starting vaccination and treatment when indicated. Results: A total of 1,317 participants were recruited from the five study locations: Campo Grande (n=181, 13.7%), Manaus (n=340, 25.8%), Porto Alegre (n=192, 14.6%), Salvador (n=201, 15.3%), and São Paulo (n=403, 30.6%). The recruitment period varied at each study location due to logistic constraints imposed by the COVID-19 pandemic. Conclusion: Despite the enormous challenges posed by the co-occurrence of the COVID-19 pandemic and field work targeting a vulnerable, elusive, and scattered population, the TransOdara project has been effectively implemented. Caveats did not preclude 1,300 TGW from being interviewed and tested, amid a significant epidemic that disrupted health services and research projects in Brazil and worldwide.

RESUMO Objetivo As infecções sexualmente transmissíveis (IST) afetam desproporcionalmente as mulheres trans e travestis (MTT), que muitas vezes não têm acesso a cuidados de saúde devido ao estigma e à discriminação. Descrevemos a abordagem e a metodologia de um estudo que investigou a prevalência de sífilis, HIV, hepatite A, B e C, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) e papilomavírus humano (HPV) entre as MTT, bem como seu conhecimento e percepção sobre a sífilis, para melhor as políticas para redução de IST nessa população vulnerável. Métodos: TransOdara foi um estudo multicêntrico, transversal, realizado em cinco capitais das principais regiões brasileiras entre dezembro de 2019 e julho de 2021. Mulheres autoidentificadas como mulheres trans ou travestis, com idade >18 anos, foram recrutadas usando respondent-driven sampling, após uma fase de pesquisa formativa. Responderam a um questionário conduzido por entrevistadoras. Foi oferecida consulta médica, com exame físico, e solicitou-se que fornecessem amostras de vários locais para detectar as IST citadas. Quando indicado e consentido, foram iniciadas a vacinação e o tratamento. Resultados: Foram recrutadas 1.317 participantes nos cinco locais de estudo: Campo Grande (n=181, 13,7%), Manaus (n=340, 25,8%), Porto Alegre (n=192, 14,6%), Salvador (n= =201, 15,3%) e São Paulo (n=403, 30,6%). O período de recrutamento variou em cada local em razão de restrições logísticas impostas pela pandemia de COVID-19. Conclusão: Apesar dos enormes desafios colocados pela ocorrência simultânea da pandemia da COVID-19 e do trabalho de campo dirigido a uma população vulnerabilizada e dispersa, o projeto TransOdara foi eficazmente implementado. As adversidades não impediram que mais de 1.300 mulheres trans e travestis tenham sido entrevistadas e testadas em meio a uma epidemia de tal magnitude que perturbou os serviços de saúde e os projetos de pesquisa no Brasil e no mundo.

Bodies of desire: use of nonprescribed hormones among transgender women and travestis in five Brazilian capitals (2019-2021) / Corpos do desejo: uso de hormônios sem prescrição médica entre mulheres trans e travestis em cinco capitais brasileiras (2019-2021)

ABSTRACT Objective: To analyze the experiences of transgender women and travestis regarding the use of hormones for body changes without a medical prescription. Methods: This is a cross-sectional, quantitative and qualitative study, using data from "TransOdara", which estimated the prevalence of Sexually Transmitted Infections in transgender women and travestis recruited through Respondent-Driven Sampling, between December 2019 and July 2021, in São Paulo, Campo Grande, Manaus, Porto Alegre, and Salvador, Brazil. The main outcome was: use of hormones without medical prescription and associated risk factors. Descriptive analysis, mixed univariate logistic regression models, and semi-structured interviews were carried out. Results: Of the 1,317 recruited participants, 85.9% had already used hormones. The current use of hormones was reported by 40.7% (536) of them. Of those who were able to inform the place where they obtained them, 72.6% (381/525) used them without a medical prescription. The variables associated with the outcome were: current full-time sex work (OR 4.59; 95%CI 1.90-11.06) or in the past (OR 1.92; 95%CI 1.10-3.34), not having changed their name (OR 3.59; 95%CI 2.23-5.76), not currently studying (OR 1.83; 95%CI 1.07-3.13), being younger (OR 2.16; 95%CI 1.31-3.56), and having suffered discrimination at some point in life for being a transgender women and travestis (OR 0.40; 95%CI 0.20-0.81). Conclusion: The use of nonprescribed hormones is high among transgender women and travestis, especially among those who are younger, did not study, have not changed their name, and with a history of sex work. This use is related to the urgency for gender transition, with excessive use and damage to health.

RESUMO Objective Analisar experiências de mulheres trans e travestis com o uso de hormônios para mudança corporal sem prescrição médica. Métodos: Estudo de corte transversal, quantitativo e qualitativo, utilizando um recorte do TransOdara, que estimou prevalência de Infecções Sexualmente Transmissíveis em mulheres trans e travestis, recrutadas por meio de Respondent-Driven Sampling, entre dezembro de 2019 e julho de 2021, em São Paulo, Campo Grande, Manaus, Porto Alegre e Salvador. Principal desfecho: uso de hormônios sem prescrição médica e fatores associados. Foram realizados análise descritiva e modelos de regressão logísticos univariados mistos e entrevistas semiestruturadas. Resultados: Das 1.317 participantes recrutadas, 85,9% já haviam usado hormônios. O uso atual de hormônios foi referido por 40,7% (536) delas. Das que souberam informar o local onde os conseguiram, 72,6% (381/525) faziam uso sem prescrição médica. As variáveis associadas ao uso sem prescrição foram: exercer trabalho sexual em tempo integral (OR 4,59; IC95% 1,90-11,06) ou no passado (OR 1,92; IC95% 1,10-3,34); não ter retificado o nome (OR 3,59; IC95% 2,23-5,76); não estar estudando (OR 1,83; IC95% 1,07-3,13); ser mais jovem (OR 2,16; IC95% 1,31-3,56); ter sofrido discriminação em algum momento na vida por ser mulheres trans e travestis (OR 0,40 - IC95% 0,20-0,81). Conclusão: O uso de hormônios não prescritos é alto entre mulheres trans e travestis, principalmente entre as mais jovens, as que não estudavam, as que não retificaram o nome e as com histórico de trabalho sexual. Está relacionado à urgência para a transição de gênero, com uso exagerado e danos à saúde.

Hepatitis A, B and C prevalence among transgender women and travestis in five Brazilian capitals between 2019-2021 / Prevalência das hepatites A, B e C entre mulheres trans e travestis em cinco capitais brasileiras entre 2019-2021

ABSTRACT Objective: To estimate the prevalence and factors associated with hepatitis A, B, and C in transgender women and travestis's networks, in 5 regions of Brazil. Methods: This cross-sectional study includedtransgender women and travestis in five Brazilian capitals (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo), between December/2019 and July/2021. All samples were subjected to detection of serological markers of hepatitis virus A (HAV), B (HBV), and C (HCV) infections through rapid tests and chemiluminescent microparticle immunoassays. Positive samples in the screening tests were submitted to detect HBV DNA and HCV-RNA by real-time PCR and genotyped by Sanger sequencing. Results: Analysis of 1,317 samples showed network prevalence rates of 69.1%, 25.1%, and 1.5% for HAV, HBV, and HCV exposure, respectively. A high susceptibility rate to HBV infection (35.7%) and low prevalence of vaccine response markers (40%) were also observed. Age greater than 26 years, self-declared black/brown skin color, having only primary education, history of incarceration, and use of a condom in the last sexual intercourse with a casual partner were associated with total anti-HAV. Exposure to HBV was associated with age greater than 26 years, self-declared black/brown, history of being a sex worker, and incarceration. Age > 37 years, history of sexual abuse, and frequent alcohol consumption were associated with hepatitis C infection. Conclusion: The highest prevalence of HAV in this population was found in the North and Northeast regions, and the prevalence found was higher than that in the general population, suggesting greater vulnerability. The prevalence of HCV infection in our study was similar to that observed in the general population.

RESUMO Objetivo: Estimar as prevalências e fatores associados com as hepatites A, B e C em mulheres trans e travestis em cinco regiões do Brasil. Métodos: Estudo transversal com mulheres trans e travestis em cinco capitais brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo), entre dezembro/2019 e julho/2021. As amostras foram submetidas à detecção de marcadores das infecções pelos vírus das hepatites A (HAV), B (HBV) e C (HCV), utilizando-se testes rápidos e quimioluminescência. Amostras positivas foram submetidas à detecção de HBV-DNA e HCV-RNA por PCR em tempo real e genotipadas por sequenciamento de Sanger. Resultados: As análises de 1.317 amostras indicaram taxas de prevalências nas mulheres trans e travestis recrutadas de 69,1%, 24,4% e 1,5% para exposição ao HAV, HBV e HCV, respectivamente. Elevada taxa de suscetibilidade ao HBV (35,7%) e baixa prevalência do marcador vacinal (40,0%) foram observadas. Mostraram-se associadas à presença de anti-HAV: idade maior que 26 anos, autodeclarar-se preta-parda, ter apenas educação básica, história de encarceramento e uso de preservativo na última relação sexual com parceiro casual. Quanto à exposição ao HBV, foi associada a idade maior que 26 anos, cor da pele preto-parda, ter sido profissional do sexo e história de encarceramento. Idade maior de 37 anos, história de abuso sexual e consumo frequente de álcool foram associadas ao HCV. Conclusão: As maiores prevalências de HAV nessa população encontram-se nas regiões Norte e Nordeste. Com relação ao HBV, a prevalência encontrada foi superior à encontrada na população geral, sugerindo maior vulnerabilidade. A prevalência do HCV foi semelhante à encontrada na população geral.

Prevalence of chlamydia and gonorreheae among transgender women and travestis in five Brazilian capitals, 2019-2021 / Prevalências de clamídia e gonorreia entre mulheres trans e travestis de cinco capitais brasileiras, 2019-2021

ABSTRACT Objective: To estimate the prevalence and factors associated with the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in transgender women and travestis in five Brazilian capitals. Methods: Data were obtained from a cross-sectional study conducted between 2019 and 2021, with participants recruited through Respondent Driven Sampling in São Paulo, Campo Grande, Manaus, Porto Alegre and Salvador. Detection of CT and NG was analyzed at three collection sites (anorectal, oropharyngeal and urethral). Mixed logistic regression models were employed to identify associated factors. Results: A total of 1,297 recruited participants provided biological material to detect these infections. The prevalences of CT, NG and coinfection were 11.5%, 13.3% and 3.6%, respectively. Independent associations with CT infections included past (OR=1.73; 95%CI 1.02-2.95), current (OR=2.13; 95%CI 1.23-3.69), and part-time sex work (OR=2.75; 95%CI 1.60-4.75), as well as lifetime injectable drug use (OR=3.54; 95%CI 1.49-8.40). For NG, associations were observed with lifetime injectable drug use (OR=1.91; 95%CI 1.28-2.84) and sexual orientation, including heterosexual (OR=3.44; 95%CI 1.35-8.82), homosexual (OR=5.49; 95%CI 1.89-15.97), and bisexual (OR=3.21; 95%CI 1.06-9.68). Coinfection was associated with use of illicit drugs in the last 12 months (OR=2.34, 95%CI 1.10-5.00), and younger age was associated with all investigated outcomes. Conclusion: Estimated prevalences of CT, NG and co-infection were higher among transgender women and travestis compared to the general population, particularly among younger, individuals engaged in sex work and illicit drug use.

RESUMO Objetivo: Estimar as prevalências e os fatores associados à detecção de Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) em mulheres trans e travestis em cinco capitais brasileiras. Métodos: Os dados vieram de um estudo transversal, realizado entre 2019 e 2021, com pessoas recrutadas por RDS (respondent driven sampling) em São Paulo, Campo Grande, Manaus, Porto Alegre e Salvador. Analisou-se a detecção de CT e NG, em três sítios de coleta (anorretal, orofaríngeo e uretral). Para identificação dos fatores associados empregaram-se modelos logísticos com efeitos mistos. Resultados: Forneceram material biológico para detecção dessas infecções 1.297 participantes recrutadas. As prevalências de CT, NG e coinfecção foram, respectivamente, 11,5, 13,3 e 3,6%. Foram independentemente associados à detecção para CT: trabalho sexual no passado (odds ratio — OR=1,73; intervalos de confiança para 95% — IC95% 1,02-2,95), no momento atual (OR=2,13; IC95% 1,23-3,69) e como atividade parcial (OR=2,75; IC95% 1,60-4,75) e uso de drogas injetáveis na vida (OR=3,54; IC95% 1,49-8,40). Para NG: uso de drogas injetáveis na vida (OR=1,91; IC95% 1,28-2,84) e orientação sexual - heterossexuais (OR=3,44; IC95% 1,35-8,82), homossexuais (OR=5,49; IC95% 1,89-15,97) e bissexuais (OR=3,21; IC95% 1,06-9,68). Para coinfecção: uso de drogas nos últimos 12 meses (OR=2,34; IC95% 1,10-5,00). Ser mais jovem foi associada a todos os desfechos investigados. Conclusão: As prevalências estimadas de CT, NG e de coinfecção foram desproporcionalmente mais elevadas entre as mulheres trans e travestis se comparadas à população geral, especialmente entre as mais jovens, que exerciam trabalho sexual e faziam uso de drogas.

Bodies of desire: use of nonprescribed hormones among transgender women and travestis in five brazilian capitals (2019–2021) / Corpos do desejo: uso de hormônios sem prescrição médica entre mulheres trans e travestis em cinco capitais brasileiras (2019–2021)

Objective: To analyze the experiences of transgender women and travestis regarding the use of hormones for body changes without a medical prescription. Methods: This is a cross-sectional, quantitative and qualitative study, using data from “TransOdara”, which estimated the prevalence of Sexually Transmitted Infections in transgender women and travestis recruited through Respondent-Driven Sampling, between December 2019 and July 2021, in São Paulo, Campo Grande, Manaus, Porto Alegre, and Salvador, Brazil. The main outcome was: use of hormones without medical prescription and associated risk factors. Descriptive analysis, mixed univariate logistic regression models, and semi-structured interviews were carried out. Results: Of the 1,317 recruited participants, 85.9% had already used hormones. The current use of hormones was reported by 40.7% (536) of them. Of those who were able to inform the place where they obtained them, 72.6% (381/525) used them without a medical prescription. The variables associated with the outcome were: current full-time sex work (OR 4.59; 95%CI 1.90–11.06) or in the past (OR 1.92; 95%CI 1.10–3.34), not having changed their name (OR 3.59; 95%CI 2.23–5.76), not currently studying (OR 1.83; 95%CI 1.07–3.13), being younger (OR 2.16; 95%CI 1.31–3.56), and having suffered discrimination at some point in life for being a transgender women and travestis (OR 0.40; 95%CI 0.20–0.81). Conclusion: The use of nonprescribed hormones is high among transgender women and travestis, especially among those who are younger, did not study, have not changed their name, and with a history of sex work. This use is related to the urgency for gender transition, with excessive use and damage to health.

Objetivo: Analisar experiências de mulheres trans e travestis com o uso de hormônios para mudança corporal sem prescrição médica. Métodos: Estudo de corte transversal, quantitativo e qualitativo, utilizando um recorte do TransOdara, que estimou prevalência de Infecções Sexualmente Transmissíveis em mulheres trans e travestis, recrutadas por meio de Respondent-Driven Sampling, entre dezembro de 2019 e julho de 2021, em São Paulo, Campo Grande, Manaus, Porto Alegre e Salvador. Principal desfecho: uso de hormônios sem prescrição médica e fatores associados. Foram realizados análise descritiva e modelos de regressão logísticos univariados mistos e entrevistas semiestruturadas. Resultados: Das 1.317 participantes recrutadas, 85,9% já haviam usado hormônios. O uso atual de hormônios foi referido por 40,7% (536) delas. Das que souberam informar o local onde os conseguiram, 72,6% (381/525) faziam uso sem prescrição médica. As variáveis associadas ao uso sem prescrição foram: exercer trabalho sexual em tempo integral (OR 4,59; IC95% 1,90–11,06) ou no passado (OR 1,92; IC95% 1,10–3,34); não ter retificado o nome (OR 3,59; IC95% 2,23–5,76); não estar estudando (OR 1,83; IC95% 1,07–3,13); ser mais jovem (OR 2,16; IC95% 1,31–3,56); ter sofrido discriminação em algum momento na vida por ser mulheres trans e travestis (OR 0,40 – IC95% 0,20–0,81). Conclusão: O uso de hormônios não prescritos é alto entre mulheres trans e travestis, principalmente entre as mais jovens, as que não estudavam, as que não retificaram o nome e as com histórico de trabalho sexual. Está relacionado à urgência para a transição de gênero, com uso exagerado e danos à saúde.

Infant mortality in the municipality of São Paulo: trend and social inequality (2006-2019).

OBJECTIVE: Considering the published evidence on the impact of recent economic crises and the implementation of fiscal austerity policies in Brazil on various health indicators, this study aims to analyze how the trend and socio-spatial inequality of infant mortality behaved in the municipality of São Paulo from 2006 to 2019. METHODS: This is an ecological study with a temporal trend analysis that was developed in municipality of São Paulo, using three residence area strata differentiated according to their social vulnerability following the 2010 São Paulo Social Vulnerability Index. Infant mortality rate, as well as neonatal, and post-neonatal mortality rates, were calculated for each social vulnerability stratum, each year in the period, and for the first and last three triennia. Temporal trends were analyzed by the Prais-Winsten regression model and inequality magnitude, by rate ratios. RESULTS: We found a decline in infant mortality rate and its components from 2006 to 2015, greater in the stratum with low social vulnerability and in the post-neonatal period when compared to the neonatal one. This decline ended in 2015, stagnating in the next period (2016-2019). Our analysis of infant mortality inequality across social vulnerability stratum showed a significant increase from the initial to the final triennia in the analyzed period; rate ratios increased from 1.36 to 1.48 in the high stratum (compared to the low social vulnerability stratum), and from 1.19 to 1.32 between the medium and low social vulnerability strata. CONCLUSIONS: The observed stagnation of infant mortality rate decline in 2015 and the increase in socio-spatial inequality point to the urgent need to reformulate current public policies to reverse this situation and reduce inequalities in the risk of infant death.

Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil. / Fatores associados à retenção de travestis e mulheres trans vivendo com HIV em uma intervenção com navegação de pares em São Paulo, Brasil.

Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.

Travestis e mulheres trans (TrMT) pertencem aos grupos com mais alta prevalência do HIV no mundo, com maior probabilidade de infecção em relação à população geral e menor adesão a estratégias de prevenção e tratamento do que outros grupos vulneráveis. Considerando esses desafios, descrevemos os fatores associados à retenção de TrMT com HIV no projeto TransAmigas. O recrutamento ocorreu entre abril de 2018 e setembro de 2019, em um serviço público de saúde em São Paulo, Brasil. Foram inscritas 113 TrMT, atribuídas aleatoriamente para uma intervenção com navegadora de pares (75) ou um grupo controle (38) e seguidas durante nove meses. Para analisar a associação entre as variáveis selecionadas e o desfecho ("retenção aos nove meses" independentemente do contato aos três meses, definido pela "resposta completa ao questionário final"), foram empregados modelos de regressão logística bi e multivariados. Uma exploração qualitativa dos formulários de contato de pares foi realizada para validar e complementar a seleção prévia de variáveis do componente quantitativo. Das 113 participantes, 79 (69,9%) responderam à entrevista de nove meses, sendo 54 (72%) do grupo intervenção e 25 (66%) do grupo controle. No modelo multivariado final, o contato aos três meses (odds ratio ajustado - ORa = 6,15; intervalo de 95% de confiança - 95%CI: 2,16-17,51) e a maior escolaridade (≥ 12 anos) (ORa = 3,26; IC95%: 1,02-10,42) permaneceram associados ao desfecho, ajustados por raça/cor, idade < 35 anos e revelação do status sorológico para HIV. Pesquisas futuras com TrMT devem incluir contato em intervalos regulares, com esforços adicionais voltados a participantes com menor escolaridade.

La población de travestis y mujeres trans (TrMT) está en los grupos con mayor prevalencia de VIH en el mundo, con mayor probabilidad de infección en comparación con la población general y menor adherencia a las estrategias de prevención y tratamiento que otros grupos vulnerables. Ante estos desafíos, describimos los factores asociados a la retención de TrMT con VIH en el proyecto TransAmigas. La selección ocurrió entre abril de 2018 y septiembre de 2019, en un servicio público de salud de São Paulo, Brasil. Se inscribieron 113 TrMT, a las cuales se asignaron aleatoriamente a una intervención de navegador de pares (75) o a un grupo control (38) y se les dio seguimiento durante 9 meses. Para analizar la asociación entre las variables seleccionadas y el resultado ("retención a los nueve meses" independientemente del contacto a los 3 meses, definido por "respuesta completa al cuestionario final"), se utilizaron modelos de regresión logística bi- y multivariante. Se realizó una exploración cualitativa de los formularios de contacto de pares para validar y complementar la selección previa de las variables en el componente cuantitativo. De las 113 participantes, 79 (69,9%) respondieron a la entrevista de los 9 meses, de las cuales 54 (72%) pertenecían al grupo intervención y 25 (66%) al grupo control. En el modelo multivariante final, el contacto a los 3 meses (odds ratio ajustado - ORa = 6,15; intervalo de 95% de confianza - IC95%: 2,16-17,51) y un alto nivel de instrucción (≥ 12 años) (ORa = 3,26; IC95%: 1,02-10,42) permanecieron asociados con el resultado, ajustado por etnia/color, edad < 35 años y divulgación del estado serológico respecto al VIH. Los futuros estudios con la población TrMT deberán incluir contacto a intervalos regulares, con esfuerzos adicionales dirigidos a las participantes con menor nivel de instrucción.

Estudo TransOdara: prevalência de HPV entre travestis e mulheres transexuais em situação de vulnerabilidade social em Manaus, Amazonas, Brasil / TransOdara study: HPV Prevalence among travestis and transsexual women in social vulnerability situation in Manaus, Amazonas, Brazil

Objetivo: Estimar a prevalência do papilomavírus humano (HPV) e avaliar a indicação e completude da vacinação contra o HPV entre travestis e mulheres transexuais (TrMT) em situação de vulnerabilidade social, participantes de estudo transversal multicêntrico (TransOdara), em Manaus, Amazonas (2020-2021). Métodos: O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando Respondent-Driven Sampling. A variável dependente foi o resultado positivo para HPV, analisado por meio do resultado do swab anal e swab genital. Resultados: Participaram 39 TrMT. Cerca de 50% tinham entre 20 e 29 anos, com até Ensino Fundamental incompleto/completo e 81,6% identificaram-se como pretas/pardas. Um total de 97,4% apresentou infecção anal pelo HPV e 53,8%, infecção genital. As prevalências foram significativamente maiores entre as imigrantes (88,9%) e em situação de rua (72,7%) do que entre as privadas de liberdade (26,3%) (p = 0,003). Conclusão: Para reduzir a alta prevalência de HPV entre TrMT em situação de vulnerabilidade social, é importante aprimorar as políticas públicas vigentes e estabelecer estratégias de prevenção (ampliação da cobertura de imunização/diagnóstico precoce) e tratamento oportuno para melhor qualidade de vida.

Objective: To estimate the prevalence of human papillomavirus (HPV) and evaluate the indication and completeness of vaccination against HPV among 'travestis" and transsexual women (TrTW) in vulnerable social, participants of a multicenter cross-sectional study (TransOdara), in Manaus, Amazonas (2020-2021). Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of the Policlínica Pam/Codajás, using Respondent-Driven Sampling. The dependent variable was the positive result for HPV, analyzed through the result of the anal swab and genital swab. Results: 39 participated TrTW. About 50% were between 20 and 29 years old, with incomplete/complete Elementary School and 81.6% identified themselves as black/brown. A total of 97.4% had anal HPV infection and 53.8%, genital infection. Prevalences were significantly higher among immigrants (88.9%) and homeless (72.7%) than among those incarcerated (26.3%) (p = 0.003). Conclusion: To reduce the high prevalence of HPV among TrMT in socially vulnerable situations, it is important to improve current public policies and establish prevention strategies (expansion immunization coverage/early diagnosis) and timely treatment for better quality of life

Prevalência de hepatite B e hepatite C entre travestis e mulheres transexuais em situação de alta vulnerabilidade social participantes do estudo TransOdara - Manaus, Amazonas, 2020-2021 / Prevalence of hepatitis B and hepatitis C among travestis and transsexual women in vulnerable situation, participants of the TransOdara Study ­ Manaus, Amazonas, 2020-2021

Introdução: Travestis e mulheres transexuais (TrMT) apresentam taxas desproporcionalmente elevadas de IST em comparação com o restante da população. Este estudo objetiva estimar a prevalência de hepatites B e C (VHB e VHC ) entre TrMT de três subgrupos de alta vulnerabilidade social, advindas do estudo TransOdara, na cidade de Manaus, no período de novembro de 2020 a abril de 2021. Metodologia:O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando-se Respondent-Drive Sampling. Resultados: Foram selecionadas 39 TrMT participantes, das quais 48,7% estavam em situação prisional, 28,2% em situação de área livre e 23,1% eram imigrantes. Apenas 2,5% das participantes foram diagnosticadas com VHB e 5,3% com VHC. Conclusão: Como as hepatites B e C são consideradas evitáveis, é necessário capacitar os profissionais da Rede Municipal de Saúde para reduzir o estigma e discriminação com que são tratadas e ampliar o acesso dessa população aos recursos de prevenção e tratamento disponíveis no Sistema Único de Saúde (SUS)

Introduction: Travestis and transgender women (TrTW) have disproportionately high STI rates compared to the general population. This study aims to estimate the prevalence of hepatitis B and C (HBV and HBC) among TrTW of three subgroups of high social vulnerability, resulting from the study TransOdara, in the city of Manaus, from November 2020 to April 2021. Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of the Pam/Codajás Polyclinic, using Respondent-Drive Sampling. Results: 39 TrTW participants were selected, from which 48.7% were incarcerated, 28.2% were homeless and 23.1% were immigrants. Only 2.5% of participants were diagnosed with HBV and 5.3% with HCV. Conclusion: Since Hepatitis B and C are considered preventable, it is necessary to train professionals in the City Health Network to reduce the stigma and discrimination with which they are treated and expand access to this population to prevention and treatment resources available in the Unified Health System (SUS)

Prevalência de sífilis entre travestis e mulheres transexuais em situação vulnerável, participantes do estudo TransOdara ­ Manaus, Amazonas, 2020-2021 / Prevalence of syphilis among travestis and transsexual women in vulnerable situation, participants in the TransOdara study ­ Manaus, Brazil, 2020-2021

Objetivo: Estimar a prevalência de sífilis entre travestis e mulheres transexuais (TrMT) em situação de vulnerabilidade social. Métodos: Foram selecionadas TrMT residentes em Manaus, em situação de rua, privadas de liberdade e imigrantes, participantes do projeto multicêntrico TransOdara ­ Estudo de Prevalência da Sífilis e outras Infecções Sexualmente Transmissíveis entre TrMT no Brasil: Cuidado e Prevenção. Resultados: Foram incluídas 39 TrMT. A prevalência de sífilis, segundo resultado de teste rápido e VDRL, foi 64,1% (25/39), sendo aparentemente maior entre as TrMT em situação de rua (72,7%), seguidas das privadas de liberdade (63,2%) e das imigrantes (55,6%), porém sem diferença estatística entre os subgrupos. Cerca de 80% tinham entre 20 e 39 anos e se autorreferiram pretas/pardas. Discussão: Apesar do pequeno tamanho amostral, destaca-se a especificidade deste trabalho, que incluiu população vulnerável. Conclusão: Foi alta a prevalência de sífilis na população estudada, sendo necessário ampliar os serviços capacitados para atender essa demanda

Objective: To estimate the prevalence of syphilis among travestis and transsexual women (TrTW) in situations of social vulnerability. Methods: TrTW residents in Manaus, homeless, incarcered and immigrants, participants of the multicenter project TransOdara - Prevalence Study of Syphilis and other Sexually Transmitted Infections among TrMT in Brazil: Care and Prevention were selected. Results: 39 TrMT were included. The prevalence of syphilis, according to the result of the rapid test and VDRL, was 64.1% (25/39), being apparently higher among homeless TrMT (72.7%), followed by those incarcereted (63.2 %) and immigrants (55.6%), but with no statistical difference between the subgroups. About 80% were between 20 and 39 years old and self-reported as black/brown. Discussion: Despite the small sample size, the specificity of this work stands out, which included a vulnerable population. Conclusion:The prevalence of syphilis in the studied population was high, and it is necessary to expand the services trained to meet this demand.

Prevalência de clamídia e gonorreia entre travestis e mulheres transexuais em situação vulnerável participantes do Estudo TransOdara ­ Manaus, Amazonas / Prevalence of Chlamydia and Gonorrhea among travestis and transsexual women in vulnerable situation, participants of the TransOdara Study ­ Manaus, Amazonas

Introdução: Infecções bacterianas por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) estão entre as de transmissão sexual mais prevalentes no mundo. Objetivos: Estimar a prevalência de CT eNG edescrever características sociodemográficas de travestis e mulheres transexuais (TrMT), participantes do estudo multicêntrico TransOdara, de três subgrupos de vulnerabilidade social, residentes em Manaus, Amazonas (2020 a 2021). Metodologia:O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando Respondent-Drive Sampling. A variável dependente foi o resultado reagente para CT eNG (urina e swab anal e orofaringe). Foram considerados casos positivos as que tiveram resultado positivo em pelo menos um dos três testes. As variáveis foram descritas por meio de frequências relativas e absolutas, estratificadas nos três subgrupos para CT e NG. O teste de hipótese utilizado foi o Qui quadrado de Pearson e o Exato de Fisher. Nível de significância adotado foi de 5%. Resultados: Participaram 39 TrMT [19 (48,7%) em situação prisional; 11 (28,2%) em situação de rua e 9 (23,0%) imigrantes]. 48,7% tinham entre 20 e 29 anos; 46,2%, ensino fundamental; e 81,6% eram pretas/pardas. As maiores proporções de casos confirmados para CT eNG foram entre as TrMT imigrantes (22,2% e 44,4%, respectivamente). Conclusão: Novas pesquisas com TrMT são necessárias para identificar estratégias de prevenção e práticas de rastreio mais efetivas para essas infecções.

Introduction: Bacterial infections by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the most prevalent sexually transmitted infections in the world. Objectives: To estimate the prevalence of CT and NG and to describe sociodemographic characteristics of travestis and transgender women (TrTW), participants of the multicenter study TransOdara, from three subgroups of social vulnerability, living in Manaus, Amazonas (2020 to 2021). Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of Policlínica Pam/Codajás, using Respondent-Drive Sampling. The dependent variable was the reagent result for CT and NG (urine and anal and oropharyngeal swab). Those with a positive result in at least one of the three tests were considered positive cases. Variables were described using relative and absolute frequencies, stratified into the three subgroups for CT and NG. The hypothesis test used was Pearson's Chi square and Fisher's Exact. The significance level adopted was 5%. Results: 39 TrMT participated. [19 (48.7%) in prison; 11 (28.2%) on the streets and 9 (23.0%) immigrants]. 48.7% were between 20 and 29 years old; 46.2% elementary school; 81.6% black/brown. The highest proportio ns of confirmed cases for CT and NG were among immigrant TrMT (22.2% and 44.4%, respectively). Conclusion: Further research with TrMT is needed to identify more effective prevention strategies and screening practices for these infections.

Distribuição espacial de travestis e mulheres transexuais com teste rápido positivo para sífilis e HIV, participantes do estudo TransOdara ­ Município de São Paulo, 2020 / Spatial distribution of travestis and transexual women with rapid positive tests for syphilis and HIV ­ Sao Paulo City, 2020

Introdução: No Brasil, há escassez de estudos relacionados à população trans, o que restringe a compreensão do seu perfil de saúde e adoecimento. O presente trabalho utilizou dados do Projeto TransOdara ­ "Estudo de prevalência da sífilis e outras infecções sexualmente transmissíveis entre travestis e mulheres transexuais (TrMT) no Brasil: cuidado e prevenção", estudo multicêntrico, que recrutou maiores de 18 anos e objetivou estimar a prevalência da sífilis, infecção pelo HIV e outras infecções sexualmente transmissíveis (IST). Objetivos: Analisar a distribuição espacial de TrMT, segundo resultados de testes rápidos para sífilis e HIV, por áreas de exclusão e inclusão social, de participantes recrutadas no MSP. Métodos: Utilizou-se técnica de amostragem indicada para populações de difícil acesso e foram oferecidos a todas as participantes testes laboratoriais e consultas médicas. Os endereços das participantes foram geoprocessados e referenciados a Distritos Administrativos classificados segundo Índice de Exclusão/Inclusão. Foram selecionadas 339 residentes no município de São Paulo, das quais 332 tiveram seus endereços mapeados. Resultados: Observou-se que as participantes moravam predominantemente em áreas com algum grau de exclusão social, com concentração na região central da cidade. Foram confirmadas altas prevalências de sífilis e HIV, mas o local de moradia não parece ter sido determinante como risco para sua aquisição. Foram significativamente associados com o risco de IST: a baixa escolaridade, a cor preta ou parda e a atuação como profissionais do sexo. Conclusão: Foi possível identificar, dentro deste grupo vulnerável, um subgrupo com vulnerabilidades específicas e mais acentuadas e permitiu caracterizar formas específicas de ocupação dos territórios da cidade. Sugere-se a diversificação das estratégias de testagem para alcançar populações-chave invisibilizadas e de difícil alcance, que não frequentam rotineiramente serviços de saúde

Introduction: In Brazil, there is a shortage of studies related to the transgender population, which restricts the understanding of their health and illness profile. The present work used data from the TransOdara Project ­ "Study of the prevalence of syphilis and other sexually transmitted infections among travestis and transgender women (TrTW) in Brazil: care and prevention", a multicenter study, which recruited people over 18 years of age and aimed to estimate the prevalence syphilis, HIV infection and other sexually transmitted infections (STIs). Objectives: To analyze the spatial distribution of TrTW, according to the results of rapid tests for syphilis and HIV, by areas of exclusion and social inclusion, of participants recruited in São Paulo city. Methods: A sampling technique indicated for difficult-to-access populations was used, and laboratory tests and medical consultations were offered to all participants. The participants' addresses were geoprocessed and referenced to Administrative Districts classified according to the Exclusion/Inclusion Index. 339 residents of the city of São Paulo were selected, of which 332 had their addresses mapped. Results: It was observed that the participants predominantly lived in areas with some degree of social exclusion, with a concentration in the central region of the city. High prevalences of syphilis and HIV were confirmed, but the place of residence does not seem to have been a determining factor in the risk of acquiring it. The following were significantly associated with the risk of STIs: low education, being black or brown and working as sex workers. Conclusion: It was possible to identify, within this vulnerable group, a subgroup with specific and more accentuated vulnerabilities and to characterize specific forms of occupation of the city's territories. The results suggest the diversification of testing strategies to reach key populations that are invisible and hard to reach, who do not routinely attend health services.

Prevalência de HIV entre travestis e mulheres transexuais em situação de vulnerabilidade social ­ Manaus, Amazonas, 2020-2021 / HIV prevalence among travestis and transsexual women in vulnerable situation ­ Manaus, Amazonas, 2020-2021

Introdução: É alta a prevalência de HIV entre travestis e mulheres transexuais (TrMT). Objetivo: Estimar a prevalência do HIV nessa população e descrever as características socioeconômicas de TrMT de três subgrupos com alta vulnerabilidade social. Metodologia: Estudo descritivo, com dados de participantes recrutadas em Manaus, de novembro de 2020 a abril de 2021, pelo estudo multicêntrico ­ TransOdara. Foram realizadas entrevistas estruturadas e teste rápido para HIV. As variáveis foram descritas em frequências absolutas e relativas. Resultados: Participaram 39 TrMT (48,7% em situação prisional; 28,2% em situação de rua; e 23,1% imigrantes). Cerca de 50% das participantes tinham entre 20 e 29 anos, com até 8 anos de estudo, e 81,6% eram pretas ou pardas. A prevalência de HIV foi 23,1% (9/39), sem diferença estatística entre os subgrupos analisados (p = 0,090). Conclusão: A alta prevalência de HIV entre as TrMT selecionadas requer o aprimoramento de estratégias direcionadas para ampliar o acesso dessa população à saúde.

Introduction: The prevalence of HIV among travestis and transgender women (TrTW) is high. Objective: To estimate the prevalence of HIV in this population and describe the socioeconomic characteristics of TrTW in three subgroups with high social vulnerability. Methods: Descriptive study, with data from participants recruited in Manaus, from November 2020 to April 2021, by the multicenter study - TransOdara. Structured interviews and a rapid HIV test were carried out. Variables were described in absolute and relative frequencies. Results: 39 TrMT participated (48.7% incarcereted, 28.2% in homeless, and 23.1% immigrants). About 50% of the participants were between 20 and 29 years old, with up to 8 years of study, and 81.6% were black or brown. HIV prevalence was 23.1% (9/39), with no statistical difference between the analyzed subgroups (p = 0.090). Conclusion: The high prevalence of HIV among the selected TrMT requires the improvement of targeted strategies to expand this population's access to health.