Cyrus Elena, Lama Javier R, Sanchez Jorge, Sullivan Daniell S, Leon Segundo, Villaran Manuel V, Vagenas Panagiotis, Vu David, Coudray Makella, Altice Frederick L
Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States of America.
Department of Global Health, Yale School of Public Health, New Haven, CT, United States of America.
PLOS Glob Public Health. 2023 Jan 12;3(1):e0001464. doi: 10.1371/journal.pgph.0001464. eCollection 2023.
Characterization of HIV risk factors among transwomen and men who have sex with men (MSM) should be assessed separately and independently. However, due to several constraints, these populations continue to be conflated in clinical research and data. There are limited datasets globally powered to make such comparisons. The study aimed to use one of the largest surveys of transwomen and MSM in Latin America to determine differences in HIV risk and related correlates between the two populations. Secondary data analysis was completed using a cross-sectional biobehavioral survey of 4413 MSM and 714 transwomen living in Perú. Chi Square analysis of selected HIV correlates was conducted to examine differences between transwomen and MSM. Additionally, stratified binary logistic regression was used to split data for further comparative analyses of correlates associated with transwomen and MSM separately. HIV prevalence among transwomen was two-fold greater than among MSM (14.9% vs. 7.0%, p<0.001). Transwomen had a higher prevalence of most HIV risk factors assessed, including presence of alcohol dependence (16.4% vs. 19.0%; p < .001) and drug use in the past 3 months (17.0% vs. 14.9%). MSM were more likely to use marijuana (68.0% vs. 50.0%, p < .001), and transwomen were more likely to engage in inhaled cocaine use (70.0% vs. 51.1%, p < .001). The regression exposed differences in correlates driving sub-epidemics in transwomen vs. MSM, with a trend of substance use increasing HIV risk for transwomen only. Transwomen were more likely to be HIV-infected and had different risk factors from MSM. Targeted prevention strategies are needed for transwomen that are at highest risk. Additionally, further research is needed to determine if these observations in Perú regarding substance use patterns and the role of substance use in HIV risk relate to other trans populations globally.
对跨性别女性和男男性行为者（MSM）中的艾滋病毒风险因素进行特征描述时，应分别且独立地进行评估。然而，由于多种限制因素，这些人群在临床研究和数据中仍被混为一谈。全球范围内能够进行此类比较的数据集有限。该研究旨在利用拉丁美洲针对跨性别女性和男男性行为者开展的规模最大的调查之一，来确定这两个人群在艾滋病毒风险及相关关联因素方面的差异。通过对居住在秘鲁的4413名男男性行为者和714名跨性别女性进行横断面生物行为调查，完成了二次数据分析。对选定的艾滋病毒关联因素进行卡方分析，以检验跨性别女性和男男性行为者之间的差异。此外，还使用分层二元逻辑回归对数据进行拆分，以便分别对与跨性别女性和男男性行为者相关的关联因素进行进一步比较分析。跨性别女性中的艾滋病毒流行率是男男性行为者的两倍（14.9% 对 7.0%，p<0.001）。在评估的大多数艾滋病毒风险因素中，跨性别女性的流行率更高，包括酒精依赖（16.4% 对 19.0%；p <.001）以及过去3个月内使用毒品（17.0% 对 14.9%）。男男性行为者更有可能使用大麻（68.0% 对 50.0%，p <.001），而跨性别女性更有可能吸食可卡因（70.0% 对 51.1%，p <.001）。回归分析揭示了跨性别女性与男男性行为者中导致亚流行的关联因素存在差异，且只有跨性别女性存在物质使用增加艾滋病毒风险的趋势。跨性别女性感染艾滋病毒的可能性更高，且与男男性行为者有不同的风险因素。对于风险最高的跨性别女性，需要有针对性的预防策略。此外，还需要进一步研究来确定秘鲁在物质使用模式以及物质使用在艾滋病毒风险中的作用方面的这些观察结果是否与全球其他跨性别群体相关。
