Lapadula Giuseppe, Soria Alessandro, Modesti Massimo, Vecchi Arianna, Sabbatini Francesca, Monopoli Antonia, Squillace Nicola, Lungu Eugenia, Coloma Jessenia, Columpsi Paola, Cristiano Vincenzo, Bonfanti Paolo
School of Medicine, University of Milan-Bicocca, Monza, Italy
Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy.
Sex Transm Infect. 2023 Feb;99(1):41-46. doi: 10.1136/sextrans-2021-055270. Epub 2022 Mar 29.
Transgender women sex workers (TGW-SW) are disproportionally affected by HIV and have reduced access to testing. Moreover, information regarding their behaviours and health needs is scarce.
A behavioural survey and a targeted testing programme in prostitution sites were conducted in Milan and Monza areas. The non-profit organisation 'ALA Milano Onlus' and 'San Gerardo' Hospital (Monza) implemented a mobile HIV testing unit involving a TGW peer educator, four physicians, a counsellor, a psychologist and a cultural mediator. All TGW-SW were offered anonymous HIV and hepatitis C virus (HCV) oral testing and asked to fill a questionnaire on sexual habits, drug abuse, and knowledge and attitudes towards HIV and STDs.
Between May and July 2017, 130 TGW-SW, predominantly migrants, were contacted during 15 street visits; among them, 78 (60%) were interviewed. HIV and HCV testing were accepted by 53 (42%) and 67 (52%) TGW-SW, respectively. Twenty-five (19.8%) subjects who reported already established HIV infection were not retested. Seven patients received a new diagnosis of HIV, while nobody tested positive for HCV. Overall, HIV prevalence was 13.2% (25% including those with already known HIV infection). Recent arrival in Italy and young age were associated with risk of undiagnosed HIV infection. Inconsistent condom use was commonly reported during commercial sex (27%) and with non-commercial partners (64%). Alcohol and cocaine abuse were common problems which facilitated risky behaviours.
Oral rapid HIV and HCV testing for TGW-SW in outreach settings were feasible and acceptable and led to a considerable number of new diagnoses. Interventions tailored to TGW-SW, focused on HIV prevention, testing and engagement in care, are fundamental.
跨性别女性性工作者（TGW-SW）受艾滋病毒影响的比例过高，且检测机会减少。此外，关于她们行为和健康需求的信息匮乏。
在米兰和蒙扎地区的卖淫场所开展了一项行为调查和针对性检测项目。非营利组织“ALA Milano Onlus”和“圣杰拉尔多”医院（蒙扎）设立了一个流动艾滋病毒检测单元，其中包括一名TGW同伴教育者、四名医生、一名顾问、一名心理学家和一名文化调解人。为所有TGW-SW提供了匿名艾滋病毒和丙型肝炎病毒（HCV）口腔检测，并要求她们填写一份关于性行为习惯、药物滥用以及对艾滋病毒和性传播感染的知识与态度的问卷。
2017年5月至7月期间，在15次街头走访中联系了130名TGW-SW，其中大多数是移民；对其中78人（60%）进行了访谈。分别有53名（42%）和67名（52%）TGW-SW接受了艾滋病毒和HCV检测。25名（19.8%）报告已确诊感染艾滋病毒的受试者未接受重新检测。7名患者被新诊断出感染艾滋病毒，而无人HCV检测呈阳性。总体而言，艾滋病毒感染率为13.2%（包括那些已知感染艾滋病毒的人在内为25%）。近期抵达意大利和年轻与未确诊艾滋病毒感染风险相关。在商业性行为（27%）和与非商业性伴侣性行为（64%）期间，避孕套使用不一致的情况普遍存在。酒精和可卡因滥用是常见问题，助长了危险行为。
在外展环境中为TGW-SW进行艾滋病毒和HCV快速口腔检测是可行且可接受的，并导致了相当数量的新诊断。针对TGW-SW量身定制的干预措施，重点是艾滋病毒预防、检测和参与治疗，至关重要。
