Ferreira Ana Cristina Garcia, Coelho Lara Esteves, Jalil Emilia Moreira, Luz Paula Mendes, Friedman Ruth K, Guimarães Maria Regina C, Moreira Rodrigo C, Eksterman Leonardo F, Cardoso Sandra Wagner, Castro Cristiane V, Derrico Monica, Moreira Ronaldo I, Fernandes Biancka, Monteiro Laylla, Kamel Luciana, Pacheco Antonio G, Veloso Valdilea G, Grinsztejn Beatriz
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Transgend Health. 2019 Apr 5;4(1):107-117. doi: 10.1089/trgh.2018.0063. eCollection 2019.
Worldwide, the burden of adverse health conditions is substantial among travestis and transgender women (trans women). Transcendendo, the first trans-specific cohort in a low- or middle-income country, is an open cohort established in August 2015 to longitudinally evaluate the health aspects of trans women aged ≥18 years in Rio de Janeiro, Brazil. Study visits occur on an annual basis. Data on sociodemographics, behavioral, gender transition, affirmation procedures, hormone use, discrimination, violence, clinical and mental health, HIV prevention, and care (for those HIV-infected) are collected. Physical examination, anthropometric measurements, and laboratory tests are performed. As of July 2017, 322 trans women were enrolled in the cohort with a median age of 31.5 years (interquartile range 25.7-39.5), of whom 174 (54%) were HIV-infected. The Transcendendo baseline information reinforces the scenario of marginalization and deprivation surrounding trans women. Most participants had low income (62.0% were living with below US$ 10.00/day), showed a very high engagement in sex work (78.6%), and reported increased occurrence of sexual (46.3%) and physical (54.0%) violence. Pre-exposure peophylaxis (PReP) was used by 18.8% of the HIV-uninfected trans women, only through research participation. Positive screening for depression (57.8%) and problematic use of tobacco (56.6%), cannabis (28.9%), cocaine (23.8%), and alcohol (21.5%) were high. Almost all participants (94.8%) reported hormone use at some point, mostly without medical supervision (78.7%). Our results describe a context of exclusion experienced by trans women, exposing vulnerabilities of this population in a middle-income country, with poor access to trans-specific care, HIV prevention and care, and mental health care. Addressing transgender experiences and needs can help the development of strategies to diminish stigma, improve health care environment, guide future research on trans morbidities, substance use, and trans-specific interventions to support health-related recommendations. Ultimately, it contributes to close the gaps concerning transgender health and reinforces that trans care cannot be disentangled from the social environment that surrounds trans women.
在全球范围内，变装者和跨性别女性（跨性别女性）面临着严重的不良健康状况负担。“超越”项目是低收入或中等收入国家首个针对跨性别者的队列研究，它是一个开放队列，于2015年8月设立，旨在纵向评估巴西里约热内卢年龄≥18岁的跨性别女性的健康状况。研究随访每年进行一次。收集有关社会人口统计学、行为、性别转变、确认程序、激素使用、歧视、暴力、临床和心理健康、艾滋病毒预防以及（针对艾滋病毒感染者的）护理等方面的数据。进行体格检查、人体测量和实验室检测。截至2017年7月，该队列纳入了322名跨性别女性，中位年龄为31.5岁（四分位间距为25.7 - 39.5岁），其中174人（54%）感染了艾滋病毒。“超越”项目的基线信息强化了跨性别女性所处的边缘化和匮乏状况。大多数参与者收入较低（62.0%的人每天生活费低于10美元），从事性工作的比例非常高（78.6%），并且报告遭受性暴力（46.3%）和身体暴力（54.0%）的情况有所增加。只有通过参与研究，18.8%未感染艾滋病毒的跨性别女性使用了暴露前预防（PrEP）。抑郁症阳性筛查率（57.8%）以及烟草（56.6%）、大麻（28.9%）、可卡因（23.8%）和酒精（21.5%）的问题使用率都很高。几乎所有参与者（94.8%）都报告在某个时候使用过激素，大多数情况是在没有医学监督的情况下（78.7%）。我们的研究结果描述了跨性别女性所经历 的被排斥状况，揭示了这个中等收入国家中该人群的脆弱性，她们难以获得针对跨性别者的护理、艾滋病毒预防和护理以及心理健康护理。关注跨性别者的经历和需求有助于制定减少污名化的策略，改善医疗环境，指导未来关于跨性别者发病率、物质使用以及支持健康相关建议的跨性别者特定干预措施的研究。最终，这有助于缩小跨性别者健康方面的差距，并强化跨性别者护理与跨性别女性所处的社会环境无法分割的观点。
