Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Lancet HIV. 2017 Apr;4(4):e169-e176. doi: 10.1016/S2352-3018(17)30015-2. Epub 2017 Feb 8.
BACKGROUND: The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen in Rio de Janeiro and to identify predictors of newly diagnosed HIV infections. METHODS: We recruited transwomen from Rio de Janeiro, Brazil, by respondent-driven sampling. Eligibility criteria were self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or its metropolitan area, and having a valid peer recruitment coupon. We recruited 12 seed participants from social movements and formative focus groups who then used peer recruitment coupons to refer subsequent peers to the study. We categorised participants as HIV negative, known HIV infected, or newly diagnosed as HIV infected. We assessed predictors of newly diagnosed HIV infections by comparing newly diagnosed with HIV-negative participants. We derived population estimates with the Respondent-Driven Sampling II estimator. FINDINGS: Between Aug 1, 2015, and Jan 29, 2016, we enrolled 345 eligible transwomen. 29·1% (95% CI 23·2-35·4) of participants had no previous HIV testing (adjusted from 60 participants), 31·2% (18·8-43·6) had HIV infections (adjusted from 141 participants), and 7·0% (0·0-15·9) were newly diagnosed as HIV infected (adjusted from 40 participants). We diagnosed syphilis in 28·9% (18·0-39·8) of participants, rectal chlamydia in 14·6% (5·4-23·8), and gonorrhoea in 13·5% (3·2-23·8). Newly diagnosed HIV infections were associated with black race (odds ratio 22·8 [95% CI 2·9-178·9]; p=0·003), travesti (34·1 [5·8-200·2]; p=0·0001) or transsexual woman (41·3 [6·3-271·2]; p=0·0001) gender identity, history of sex work (30·7 [3·5-267·3]; p=0·002), and history of sniffing cocaine (4·4 [1·4-14·1]; p=0·01). INTERPRETATION: Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health-care and prevention services to curb the HIV epidemic and improve the quality of life of transwomen in Brazil. FUNDING: Brazilian Research Council, National Institute of Allergy and Infectious Diseases, Brazilian Sexually Transmitted Disease/AIDS, and Viral Hepatitis Department of the Brazilian Ministry of Health.
背景：巴西跨性别女性（跨女）中的艾滋病毒负担仍然未知。我们旨在估计里约热内卢跨女中的艾滋病毒流行率，并确定新诊断出的艾滋病毒感染的预测因素。
方法：我们通过回应者驱动抽样从巴西里约热内卢招募跨女。合格标准为自我认同为跨女，年龄在 18 岁或以上，居住在里约热内卢或其大都市区，并持有有效的同伴招募优惠券。我们招募了 12 名来自社会运动和形成性焦点小组的种子参与者，他们随后使用同伴招募优惠券将后续同伴推荐给研究。我们将参与者分为 HIV 阴性、已知 HIV 感染或新诊断为 HIV 感染。我们通过将新诊断为 HIV 感染的参与者与 HIV 阴性参与者进行比较，评估了新诊断出的 HIV 感染的预测因素。我们使用回应者驱动抽样 II 估计器得出了人口估计值。
结果：2015 年 8 月 1 日至 2016 年 1 月 29 日，我们招募了 345 名符合条件的跨女。29.1%（95%CI 23.2-35.4）的参与者之前没有进行过 HIV 检测（从 60 名参与者调整），31.2%（18.8-43.6）的参与者感染了 HIV（从 141 名参与者调整），7.0%（0.0-15.9）的参与者新诊断为 HIV 感染（从 40 名参与者调整）。我们在 28.9%（18.0-39.8）的参与者中诊断出梅毒，在 14.6%（5.4-23.8）的参与者中诊断出直肠衣原体，在 13.5%（3.2-23.8）的参与者中诊断出淋病。新诊断出的 HIV 感染与黑人种族（比值比 22.8[95%CI 2.9-178.9]；p=0.003）、跨性别女性（34.1[5.8-200.2]；p=0.0001）或变性女性（41.3[6.3-271.2]；p=0.0001）的性别认同、性工作史（30.7[3.5-267.3]；p=0.002）和嗅可卡因史（4.4[1.4-14.1]；p=0.01）相关。
解释：我们的结果表明，跨女在巴西所有高危人群中承担着最大的艾滋病毒负担。年轻参与者中 HIV 诊断的比例较高表明，需要量身定制长期的医疗保健和预防服务，以遏制艾滋病毒流行并提高巴西跨女的生活质量。
资助：巴西研究理事会、美国国立过敏和传染病研究所、巴西性传播疾病/艾滋病和病毒性肝炎部、巴西卫生部。
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