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.

Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program).

BACKGROUND: Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE: This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS: A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS: From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS: The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45204.

Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis.

Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.

Hepatitis C virus prevalence among men who have sex with men: a cross-sectional study in 12 Brazilian cities.

BACKGROUND: Despite the preventive policies adopted, reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of hepatitis C virus (HCV) infection has increased among the most vulnerable population groups, including MSM. The aim of this study was to estimate the prevalence of HCV infection and to assess risky practices among MSM from 12 Brazilian cities. METHODS: This study was carried out from June to December 2016 using respondent driven sampling (RDS). Participants completed a self-administered questionnaire to collect behavioral, socioeconomic, and demographic variables. In addition, the rapid diagnostic test (RDT) for HCV was offered. Positive results were sent to Instituto Adolfo Lutz for confirmation. RESULTS: A total of 4,176 participants were recruited and 23 samples were sent for confirmation. Of these, 16 were confirmed, resulting in a prevalence of 0.7% (95% CI: 0.3%-1.7%). The Southeast region showed a prevalence of 0.9% (95% CI: 0.3-2.6), followed by the South region, with 0.6% (95% CI: 0.2-2.1). The Northeast region had a prevalence of 0.3% (95% CI: 0.1-1.0) and the Midwest 0.1% (95% CI: 0.0-0.7). No positive cases were found in the North. Single men aged 40 years or older were the majority of participants exposed to HCV. High levels of alcohol consumption, illicit drug use, irregular condom use, in addition to infection with other STIs, were associated with exposure to HCV. CONCLUSIONS: STIs continue to be important health problems in Brazil and globally. Many STIs are inapparent for many years until they bring more serious consequences. Extra investment in HCV is also warranted, given that it can be eliminated. Relying solely on clinical data to provide information about inapparent infection, especially in stigmatized populations, will make that goal more difficult to achieve. Surveillance studies, such as the one reported here need to be repeated over time to demonstrate trends and to provide information for evaluation, program and policies. Investments in the most vulnerable populations are critical to achieve the World Health Organization global health goals including the elimination of viral hepatitis by 2030.

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.

Hepatitis B Prevalence among Men Who Have Sex with Men in Brazil.

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.

Sexual violence against men in Brazil: underreporting, prevalence, and associated factors.

OBJECTIVES: Identifying and mapping the literature regarding sexual violence against Brazilian boys and men, as well as describing its underreporting, prevalence, and associated factors. METHODS: We conducted a scoping review by searching PubMed, Biblioteca Digital Brasileira de Teses e Dissertações, Biblioteca Virtual em Saúde, Scopus, and Web of Science databases. The inclusion criteria were: (a) surveys including data on sexual violence; (b) inclusion of boys or men as victims of sexual violence; (c) presenting statistical data on prevalence, underreporting, and factors associated with sexual violence among Brazilian boys and men. RESULTS: We found a total of 1,481 papers. Ultimately, 53 were included and had their data extracted. Most studies are quantitative in nature (n = 48). The total number of participants across studies was 1,416,480 and the prevalence of sexual violence ranged from 0.1% to 71%. It is important to note that underreporting statistical data was cited in several studies. The group with the highest prevalences was men who have sex with men and those with sexual dysfunctions. Increased tendency to drug use, social isolation, unprotected anal sex, suicidal ideation, sexual dysfunction, and post-traumatic stress disorder were statistically significant predictors for having experienced sexual violence. CONCLUSIONS: Despite the prevalence of sexual violence being high against Brazilian boys and men, this area of is surprisingly understudied and there are few studies with this exclusive scope. Social cultural issues, such as sexism, contribute to the underreporting of sexual violence. Additionally, we identified issues related to mental, sexual and reproductive health to be associated with sexual violence. Based on our findings, we recommend the implementation and development of a structural infrastructure aimed at supporting boys and men who are victims of sexual violence, and preventing negative outcomes for this affected group.

Impact of the COVID-19 pandemic on the mental health of frontline healthcare workers in a highly affected region in Brazil.

BACKGROUND: The COVID-19 pandemic had a major impact on the mental health of healthcare workers (HCWs), especially in low and middle-income countries, which had to face additional political, social, and economic challenges. We thus aimed to assess the prevalence of mental health outcomes and the associated factors in HCWs treating COVID-19 patients in one of the most affected regions in Brazil. METHODS: We used the Respondent-Driven Sampling method to assess the risks of COVID-19 infection and symptoms of mental disorders in nurses, nursing technicians, and physicians who worked on the frontline in the metropolitan region of Recife. 865 healthcare workers completed a survey regarding sociodemographic data, work-related risks, and symptoms of mental disorders - SRQ-20 for common mental disorders (CMD); AUDIT-C for problematic alcohol use; GAD-7 for anxiety; PHQ-9 for depression; PCL-5 for post-traumatic stress disorder (PTSD). Gile's successive sampling estimator was used to produce the weighted estimates by professional category. A Poisson regression model with robust variance was used to analyze factors associated with a positive screening for CMD. We will present the results of a cross-sectional analysis of the mental health outcomes after the first peak of COVID-19 - from August 2020 to February 2021. RESULTS: The prevalence ratios for a positive screening for CMD were 34.9% (95% CI: 27.8-41.9) in nurses, 28.6% (95% CI: 21.3-36.0) in physicians, and 26.6% (95% CI: 16.8-36.5) in nursing technicians. Nurses presented a higher prevalence of depressive symptoms (23%). Positive screening for problematic alcohol use (10.5 to14.0%), anxiety (10.4 to 13.3%), and PTSD (3.3 to 4.4%) were similar between the professional categories. The main factors associated with CMD in nurses and physicians were related to an intrinsic susceptibility to mental illness, such as previous or family history of psychiatric disorder, and female sex. Among nurse technicians, work-related factors, such as accidents with biological material, presented the strongest association with CMD. CONCLUSION: The mental health of HCWs fighting COVID-19 in Recife was severely affected. It is crucial that healthcare services provide adequate working conditions and psychological support, investing in programs to promote and protect HCWs mental health.

Reports from the frontline: health workers describe COVID-19 risks and fears in five cities in Brazil.

BACKGROUND: Health providers are under unprecedented pressures to perform in the COVID-19 health crisis and under unprecedented risks. We initiated a large mixed-method survey of health professionals in five large metropolitan areas in Brazil to document the risks and needs of health professionals. To initiate the study, we conducted formative research. METHODS: We conducted 77 open-ended semi-structured interviews online in a convenience sample of physicians, nurses, nurse technicians, and physiotherapists in Belem, Fortaleza, Porto Alegre, Recife, and São Paulo, Brazil. Design, data collection, and analysis were informed by Rapid Ethnographic Analysis (REA). RESULTS: Responses are organized into three themes that emerged in the interviews: the lack of preparation - both locally and nationally-for the pandemic and its effects on staffing and training; the overlap of personal, family, and professional risk and consequences; and inadequately addressed anxiety and suffering among health staff. CONCLUSIONS: Our respondents were unprepared for the epidemic, especially the institutional sequelae and psychological cost. These consequences were exacerbated by both lack of leadership and sweeping changes undercutting the Brazilian health system noted by almost all participants.

[Factors associated with inconsistent condom use among men who have sex with men in Brazil and their commercial sexual partners]. / Fatores associados ao uso inconsistente de preservativo com parceiros comerciais entre homens que fazem sexo com homens no Brasil.

We aimed to analyze the factors associated with inconsistent condom use among men who have sex with men (MSM) and their commercial sexual partners in Brazil. This is a cross-sectional study with adult MSM who were recruited via respondent-driven sampling (RDS) in 12 Brazilian capitals in 2016. MSM answered a sociobehavioral questionnaire which included questions on their sexual behavior. The inconsistent use of condoms with their clientele was measured via insertive and receptive anal sex in the six months prior to our research and in their last sexual intercourse. The association between independent variables and the inconsistent use of condoms was measured via a Poisson regression model with robust variance and estimation of adjusted prevalence ratios (aPR). Data from 461 MSM were analyzed. We found a 26% prevalence of inconsistent condom use with their clientele (95%CI: 19.0-34.3, n = 123). Belonging to the lowest economic classes (D/E), having medium or low knowledge about HIV, having practiced insertive and receptive anal sex, and having never tested for HIV throughout their lives were associated with inconsistent use of condoms with their clientele. The variables associated with inconsistent use indicated that commercial sex is practiced in a context of greater vulnerability to HIV infection, referring to the need for biomedical and behavioral interventions which focus on access to and use of prevention strategies together with public policies to reduce socioeconomic inequalities among MSM who practice commercial sexual.

O objetivo foi analisar os fatores associados ao uso inconsistente de preservativo com parceiros comerciais entre homens que fazem sexo com homens (HSH) no Brasil. Foi feito um estudo transversal, com HSH adultos, recrutados por meio da técnica respondent-driven sampling (RDS), em 12 capitais brasileiras, em 2016. Os HSH responderam a um questionário sociocomportamental, que incluía questões sobre o comportamento sexual. O uso inconsistente de preservativo com parceiros comerciais foi mensurado por meio das relações sexuais anais insertivas e receptivas, ocorridas nos últimos seis meses e na última relação sexual. A associação entre as variáveis independentes e o uso inconsistente de preservativo foi mensurada utilizando o modelo de regressão de Poisson com variância robusta, com estimação de razões de prevalência ajustadas (RPa). Foram analisados dados de 461 HSH. A prevalência de uso inconsistente de preservativo com parceiros comerciais foi de 26% (IC95%: 19,0-34,3, n = 123). Pertencer às classes econômicas mais baixas (D/E), ter médio ou baixo conhecimento sobre HIV, ter praticado sexo anal insertivo e receptivo e nunca ter realizado teste para HIV na vida são fatores que estiveram associados ao uso inconsistente de preservativo com parceiros comerciais. As variáveis associadas ao uso inconsistente indicaram que o sexo comercial está sendo praticado em um contexto de maior vulnerabilidade à infecção pelo HIV. Nesse sentido, são necessárias intervenções biomédicas e comportamentais, com foco no acesso e na utilização de estratégias de prevenção, aliadas a políticas públicas para a redução de desigualdades socioeconômicas entre HSH que praticam sexo comercial.

El objetivo fue analizar los factores asociados al uso inconsistente del preservativo con las parejas comerciales entre los hombres que tienen sexo con hombres (HSH) en Brasil. Estudio transversal, con HSH adultos, reclutados a través de la técnica respondent-driven sampling (RDS), en 12 capitales brasileñas, en 2016. Los HSH respondieron a un cuestionario sociocomportamental que incluía preguntas sobre el comportamiento sexual. El uso inconsistente del preservativo con parejas comerciales se midió por las relaciones anales insertivas y receptivas que se produjeron en los últimos seis meses y por la última relación sexual. La asociación entre las variables independientes y el uso inconsistente del preservativo se midió mediante el modelo de regresión de Poisson con varianza robusta, con estimación de las razones de prevalencia ajustadas (RPa). Se analizaron los datos de 461 HSH. La prevalencia del uso inconsistente del preservativo con las parejas comerciales fue del 26% (IC95%: 19,0-34,3, n = 123). Pertenecer a las clases económicas más bajas (D/E), tener un conocimiento medio o bajo sobre el VIH, haber practicado sexo anal tanto insertivo como receptivo y no haberse sometido nunca a la prueba del VIH en su vida se asociaron con el uso inconsistente del preservativo con las parejas comerciales. Las variables asociadas al uso inconsistente indicaron que el sexo comercial se está practicando en un contexto de mayor vulnerabilidad a la infección por el VIH, refiriendo la necesidad de intervenciones biomédicas y conductuales, con un enfoque en el acceso y uso de estrategias de prevención, junto con políticas públicas para reducir las desigualdades socioeconómicas entre los HSH que practican el sexo comercial.

Association of internalised homonegativity with partner notification after diagnosis of syphilis or gonorrhoea among men having sex with men in 49 countries across four continents.

BACKGROUND: Partner notification (PN) after a sexually transmitted infection (STI) diagnosis is being promoted as a means to interrupt transmission chains. We investigated whether Internalised Homonegativity (IH) is associated with PN among men having sex with men (MSM). METHODS: PN, defined as notifying at least one partner after diagnosis of syphilis and gonorrhoea, was queried in two internet-based self-completion surveys conducted between Oct 2017 and May 2018 in 68 countries in Europe, Latin America, Canada, and the Philippines. IH is defined by a man's level of agreement or disagreement with negative social beliefs about male homosexuality. Covariates included in a multivariate regression model with a random intercept at country level were age, HIV diagnosis, partnership status, sexual self-efficacy, HIV serostatus communication during last sex with a non-steady partner, place where this partner was met, and PN-related socio-historical background of the country of residence. We grouped countries in three areas: North- and Central-Western European countries plus Canada, former socialist countries, and Latin-American/Mediterranean countries plus the Philippines. In each of the three areas individuals were assigned to 4 subgroups based on IH quartiles and PN rates were determined for each subgroup. RESULTS: PN rates were calculated for 49 countries (excluding countries with less than 10 diagnoses). Mean proportions of MSM notifying their partners were 68.1% and 72.9% after syphilis and gonorrhoea diagnoses, respectively. PN rates were lower in Latin American countries and the Philippines compared to European countries. Within Europe, a North-South divide with lower PN rates in Mediterranean countries was observed. In each of the three regions we mostly observed a stepwise increase of PN rates with decreasing IH. Regression analysis showed lower IH scores associated with higher PN rates. Higher perceived self-efficacy, living in a partnership, and HIV status communication were positively associated with PN. Men who had met their last partner in a gay social venue were more likely to have notified their partners of a syphilis diagnosis compared to men who had met this partner online. Men with diagnosed HIV were less likely to report PN. CONCLUSIONS: We could demonstrate that IH was associated with PN among MSM across all countries included in our analysis. Reducing cultural homophobia and ensuring inclusive policies may contribute to STI prevention and control.

Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil.

The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services.

Diagnóstico laboratorial da infecção pelo HIV em travestis e mulheres transexuais no Brasil, 2019-2021 / Laboratory diagnosis of HIV infection in travestis and transgender women in Brazil, 2019-2021

A prevalência de HIV em travestis e mulheres transexuais (TrMT) é desproporcionalmente maior quando comparada com a população geral do Brasil. O objetivo deste estudo foi analisar ­ por meio de ensaios molecular e sorológicos convencionais para o diagnóstico da infecção pelo HIV ­ amostras de sangue de uma população TrMT de cinco capitais brasileiras que apresentaram resultado reagente em testes rápidos (TR). Um total de 435 amostras com resultado reagente em pelo menos um TR foi encaminhado ao laboratório de referência do estado de São Paulo ­ o Instituto Adolfo Lutz (IAL) ­ para que fossem analisadas, por meio de testes laboratoriais convencionais. Das amostras avaliadas, 99,3% (432/435) foram reagentes para HIV nos testes laboratoriais convencionais, e destas, 22,7% (98/432) apresentaram carga viral HIV-1 acima de 5.000 cópias/mL e 77,3% (334/432) mostraram-se reagentes em testes sorológicos (imunoensaio de quimioluminescência ou ELISA e imunoblot rápido). As três amostras restantes (0,7%) foram classificadas como "indeterminada para HIV", com base em ensaios molecular e sorológicos convencionais. A sensibilidade analítica dos diferentes ensaios ­ molecular e sorológicos ­ utilizados neste estudo pode ter variado pela influência da imunossupressão viral do HIV-1 resultante da terapia antirretroviral (TARV). Estudos complementares são necessários para melhor entender o impacto da terapia no diagnóstico do HIV

HIV prevalence among travestis and transgender women (TrTW) is disproportionately higher when compared to the overall Brazilian population. The objective of this study was to evaluate, through conventional serological and molecular tests for the diagnosis of HIV infection, blood samples of TrTW residents of five Brazilian capitals with previous reactive HIV point-of-care rapid tests (RT). A total of 435 samples with at least one reactive HIV result on point-of-care tests were sent to the HIV reference laboratory in São Paulo State ­ the Adolfo Lutz Institute ­ for further evaluation by conventional laboratory tests. From total, 432 (99.3%) samples were reactive for HIV infection in conventional laboratory assays, comprising 98/432 (22.7%) with HIV-1 viral load over 5,000 copies/ml, and 334/432 (77.3%) reactive to serological tests (chemiluminescence immunoassay or ELISA, and rapid immunoblotting). The three remaining samples (0.7%) were classified as "indeterminate for HIV" based on conventional serological and molecular assays. Analytical sensitivity of different molecular and serological assays used in this study may have varied due to HIV-1 viral suppression resulting from antiretroviral therapy (ART). Additional studies are needed to better understand the impact of therapy on HIV diagnosis

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.