Gama Ana, Martins Maria Rosário Oliveira, Mendão Luís, Barros Henrique, Dias Sónia
a Global Health and Tropical Medicine , GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL , Lisboa , Portugal.
b Grupo de Ativistas em Tratamentos , Lisboa , Portugal.
AIDS Care. 2018 Jan;30(1):1-8. doi: 10.1080/09540121.2017.1332736. Epub 2017 May 25.
Male-to-female transgender sex workers (TSW) have been identified as a key population at risk for HIV. This study examined risk behaviors and HIV prevalence among TSW, and described health services use. A participatory cross-sectional survey was conducted with 125 TSW recruited in locations and networks where sex workers congregate. HIV-risk behaviors were common among participants. Inconsistent condom use with clients in the previous month was reported by 12.0% of participants and was associated with Portuguese nationality, inconsistent condom use with non-paying partners and not been reached by HIV prevention programs in the previous year. Ever use of psychoactive substances was reported by 61.6% of participants and was associated with being non-employed, doing full-time sex work, having higher number of non-paying partners and having never used health services. Also, ever use of psychoactive substances was negatively associated with older age and Portuguese nationality. About 34% of the participants reported having not been tested in the previous 12 months; 20.2% never used the health services. Overall, 14.9% (95%CI: 8.0-21.0%) reported being HIV-positive. Of those, 22.2% (95%CI: 1.0-43.5%) had unprotected sex with clients in the previous month, 26.7% (95%CI: 1.3-52.0%) had unprotected sex with non-paying partners in the previous year, 13.3% (95%CI: 0.0-33.0%) had ever injected drugs, 60.0% (95%CI: 23.0-97.0%) reported a past STI and 33.3% (95%CI: 2.0-64.6%) had currently HIV/STI co-infection. The socioeconomic, relational or partnering, and structural contexts conducive to increased risk are warranting further investigation. This knowledge would be valuable to inform prevention programs. HIV interventions, including secondary prevention, should address specific needs of TSW. Outreach initiatives aimed to reach TSW who are difficult to access can play a role in promoting access to health services and reducing HIV infection and transmission.
男变女跨性别性工作者（TSW）已被确定为感染艾滋病毒的关键风险人群。本研究调查了TSW的风险行为和艾滋病毒感染率，并描述了其对卫生服务的利用情况。对在性工作者聚集地点和网络招募的125名TSW进行了参与式横断面调查。参与者中普遍存在艾滋病毒风险行为。12.0%的参与者报告在上个月与客户发生性行为时未坚持使用避孕套，这与葡萄牙国籍、与非付费伴侣发生性行为时未坚持使用避孕套以及上一年未接触过艾滋病毒预防项目有关。61.6%的参与者报告曾使用过精神活性物质，这与未就业、全职从事性工作、有更多非付费伴侣以及从未使用过卫生服务有关。此外，曾使用精神活性物质与年龄较大和葡萄牙国籍呈负相关。约34%的参与者报告在过去12个月内未进行过检测；20.2%的人从未使用过卫生服务。总体而言，14.9%（95%置信区间：8.0 - 21.0%）报告为艾滋病毒阳性。其中，22.2%（95%置信区间：1.0 - 43.5%）在上个月与客户发生过无保护性行为，26.7%（95%置信区间：1.3 - 52.0%）在过去一年与非付费伴侣发生过无保护性行为，13.3%（95%置信区间：0.0 - 33.0%）曾注射过毒品，60.0%（95%置信区间：23.0 - 97.0%）报告曾患性传播感染，33.3%（95%置信区间：2.0 - 64.6%）目前患有艾滋病毒/性传播感染合并症。有利于增加风险的社会经济、关系或伴侣关系以及结构背景值得进一步调查。这些知识对于为预防项目提供信息将是有价值的。艾滋病毒干预措施，包括二级预防，应满足TSW的特定需求。旨在接触难以接触到的TSW的外展举措可在促进获得卫生服务以及减少艾滋病毒感染和传播方面发挥作用。
