Perez-Brumer Amaya G, Reisner Sari L, McLean Sarah A, Silva-Santisteban Alfonso, Huerta Leyla, Mayer Kenneth H, Sanchez Jorge, Clark Jesse L, Mimiaga Matthew J, Lama Javier R
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
The Fenway Institute, Fenway Health, Boston, MA, USA.
J Int AIDS Soc. 2017 Feb 28;20(1):21462. doi: 10.7448/IAS.20.1.21462.
In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community-level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru.
Using qualitative methodology to provide an in-depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community-level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV-related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18-44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18.
Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency-based strategies included peer-to-peer and intergenerational knowledge sharing, supportive clinical services (e.g. group-based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community).
This study highlights the importance of TW communities as support structures that create and deploy social resiliency-based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.
在秘鲁，由于限制获得艾滋病毒预防、治疗和护理服务的机会及质量的因素，跨性别女性面临感染艾滋病毒的独特风险。然而，尽管全球在了解与跨性别女性艾滋病毒易感性相关因素方面取得了最新进展，但对秘鲁跨性别女性如何应对这一现实以及尽管该群体面临普遍的社会和经济排斥，现有的社区层面复原力策略是如何实施的研究却很有限。为满足这一需求，我们的研究运用对社会资本作为健康的社会决定因素的理解，并考察其与秘鲁跨性别女性艾滋病毒易感性的关系。
我们采用定性方法以提供深入描述，评估了（1）社会边缘化、社会资本与艾滋病毒易感性之间的交叉点；以及（2）秘鲁跨性别女性采用的社区层面复原力策略，以缓冲社会边缘化并与所需的艾滋病毒相关服务建立联系。2015年1月至2月期间，48名跨性别女性（平均年龄=29岁，范围=18 - 44岁）参与了本研究，研究包括焦点小组讨论和人口统计学调查。分析以沉浸式结晶方法为指导，所有编码均使用Dedoose 6.1.18版本进行。
与艾滋病毒易感性相关的主题包括多层次污名化经历和有限的职业机会，这些使跨性别女性面临风险，并限制了她们参与现有艾滋病毒服务的程度。新出现的基于复原力的策略包括同龄人之间和代际知识共享、支持性临床服务（如集体就诊）以及通过社会凝聚力提供情感支持（即感觉自己是社区的一部分）。
本研究强调了跨性别女性社区作为支持结构的重要性，这些社区创造并部署基于社会复原力的策略，旨在阻止和减轻社会脆弱性对秘鲁个体跨性别女性的歧视、边缘化及艾滋病毒风险的影响。旨在为该人群提供艾滋病毒预防、治疗和护理的公共卫生策略将受益于认识到跨性别女性社区内现有的社会资本，并将其优势纳入艾滋病毒预防干预措施中。在艾滋病毒易感性与集体能动性的交叉点上，桥梁型和纽带型社会资本维度成为秘鲁跨性别女性用于获得所需医疗服务的复原力策略。促进跨性别女性的团结和同伴支持是确保艾滋病毒预防和推广努力的可接受性和可持续性的关键组成部分。
