HIV Voluntary Counseling and Testing (VCT-HIV) effectiveness for sexual risk-reduction among key populations: A systematic review and meta-analysis.

Background: HIV disproportionately affects people who inject drugs, transgender people, sex workers, men who have sex with men, and incarcerated people. Recognized as key populations (KP), these groups face increased impact of HIV infection and reduced access to health assistance. In 1990, the Center for Disease Control and Prevention organized technical guidance on HIV Voluntary Counseling and Testing (VCT-HIV), with subsequent trials comparing intervention methodologies, no longer recommending this strategy. However, KP needs have not been explicitly considered. Methods: We assessed VCT-HIV effectiveness for sexual risk-reduction among KP (PROSPERO 2020 CRD42020088816). We searched Pubmed, EMBASE, Global Health, Scopus, PsycINFO, and Web of Science for peer-reviewed, controlled trials from February, 2020, to April, 2022. We screened the references list and contacted the main authors, extracted data through Covidence, applied the Cochrane Risk-of-Bias tool, and performed the meta-analysis using Review Manager. Findings: We identified 17 eligible trials, including 10,916 participants and evaluated HIV risk behaviors. When compared to baseline, VCT-HIV reduced unsafe sex frequency (Z=5.40; p<0.00001, I²=0%). Interpretation: While our meta-analysis identified VCT-HIV as protective for sexual risk behaviors for among KP, the results are limited to MSM and PWID, demonstrating the paucity of data on the other KP. Also, it highlights the importance of applying a clear VCT-HIV guideline as well as properly training the counselors. Funding: Research funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ/MS-DIAHV N° 24/2019), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Atribuições de Causalidade pela Infecção por HIV / Attributions of Causality for HIV Infection / Atribuciones de Causalidad por Infección con VIH

A prevalência de HIV acomete significativamente a população brasileira. Os homens que fazem sexo com homens (HSH) e as mulheres trans são afetados desproporcionalmente pela epidemia. Evidências indicam maiores atribuições de culpa, controle e responsabilidade para pessoas que se infectam por HIV em situações de sexo desprotegido, especialmente homossexuais. Portanto, o presente estudo experimental buscou testar de que forma estudantes e profissionais da área da saúde atribuem culpa, controle e responsabilidade pela infecção por HIV. A amostra foi composta por estudantes e profissionais do município de Porto Alegre. As/os participantes do estudo foram alocadas/os randomicamente em seis cenários, que mostravam uma infecção por HIV via sexo desprotegido ou via transfusão de sangue, sendo que a identidade da pessoa da cena varia entre homem heterossexual, homem homossexual e mulher trans. Os resultados indicaram maiores atribuições de controle, culpa e responsabilidade para o homem homossexual e para a mulher trans, somente no cenário "sexo desprotegido". (AU)

The HIV epidemic is a significant problem in Brazil. Men who have sex with men (MSM) and transgender women are disproportionately affected by the epidemic. Evidence shows that attributions of onset controllability, blame, and responsibility for the HIV infection are higher in cases of unprotected sex and also when the person is homosexual. This article presents the results of an experimental study, which tested the impact of the attributions of onset controllability, blame, and responsibility for the HIV infection when a person is homosexual or transgender. The participants were allocated randomly in six experimental scenarios. The scenarios were about an HIV infection by unprotected sex or by blood transfusion. The infected patient could be a heterosexual man, homosexual man or transgender woman. Our results indicated higher attributions of onset controllability, blame, and responsibility to the homosexual man and to the transgender woman, only in cases of infection by unprotected sex. (AU)

La epidemia de VIH acomete significativamente a la población brasileña. Los hombres que tienen sexo con hombres (HSH) y las mujeres transgénero son afectados desproporcionadamente por la epidemia. Evidencias indican mayores atribuciones de culpa, control y responsabilidad para personas que se infectan por el VIH en situaciones de sexo desprotegido, especialmente homosexuales. Así, este artículo presenta y discute los resultados de un estudio experimental que buscó testar cómo las personas atribuyen culpa, control y responsabilidad por la infección por VIH. La muestra fue compuesta por estudiantes y profesionales del municipio de Porto Alegre. Las/Los participantes fueron asignadas/os al azar en seis escenarios, que mostraban una infección por VIH a través del sexo desprotegido o transfusión de sangre, con la identidad de la persona de la escena que varía entre hombre heterosexual, hombre homosexual y mujer trans. Los resultados indicaron mayores atribuciones de control, culpa y responsabilidad para el hombre homosexual y para la mujer trans, solamente en los escenarios "sexo sin protección". (AU)

HIV-related care for transgender people: A systematic review of studies from around the world.

RATIONALE: Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people. OBJECTIVE: The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people. METHOD: Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations. RESULTS: From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment. CONCLUSIONS: The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.