Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Soc Sci Med. 2019 Jun;230:280-294. doi: 10.1016/j.socscimed.2019.03.016. Epub 2019 Apr 28.
Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people.
The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people.
Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations.
From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment.
The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.
跨性别者面临着独特的挑战，例如结构性、人际和个体易患慢性病的弱点。耻辱和偏见可能会阻碍他们获得医疗保健，并阻止他们融入劳动力市场，以及导致他们遭受暴力。劳动力市场排斥促使他们从事生存性交易工作，从而增加感染艾滋病毒的脆弱性。艾滋病毒连续护理将艾滋病毒预防（包括抗逆转录病毒暴露前预防（PrEP）、抗逆转录病毒暴露后预防（PEP）和艾滋病毒检测）与护理联系起来（即启动、维持和监测抗逆转录病毒治疗）。目前，许多研究评估了跨性别者获得艾滋病毒护理的障碍和促进因素。
本系统评价旨在清楚地总结目前关于跨性别男性、跨性别女性和性别多样化人群与艾滋病毒相关护理的文献。
纳入标准为同行评议的定量研究，发表于 2018 年 4 月 4 日之前，涉及跨性别女性、跨性别男性和性别多样化人群与艾滋病毒相关护理，即任何旨在预防、治疗或减轻艾滋病毒对这些人群影响的干预措施。
从 6585 条参考文献中，共纳入 62 篇文章：3 篇文章的结果涉及 PEP，18 篇涉及 PrEP，29 篇涉及 HIV 检测，17 篇涉及获得医疗保健，13 篇涉及治疗依从性。
本研究是第一项评估跨性别者与艾滋病毒相关护理的系统评价。关于跨性别男性和性别多样化人群的数据收集仍然很少。在全球范围内，艾滋病毒感染检测不一定能使跨性别群体获得艾滋病毒连续护理，甚至不能保证他们意识到艾滋病毒血清阳性。
