Department of Epidemiology and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
LGBT Health. 2023 Oct;10(7):535-543. doi: 10.1089/lgbt.2022.0054. Epub 2023 Apr 24.
Globally, transgender women (TGW) experience wide-ranging barriers to health and care, with disproportionately high risks of infectious and chronic diseases. Yet, research on transgender populations' access to care in low- and middle-income countries remains limited, focused on human immunodeficiency virus (HIV) infection, and assesses TGW as a homogenous group. We analyzed morbidity and health service uptake patterns among TGW in Lima, Perú, to understand health outreach and service needs to inform targeting and design of community-level interventions. This cross-sectional study surveyed a convenience sample of 301 TGW in metropolitan Lima during September-October 2020. We report descriptive statistics and bivariable and multivariable regression model results as adjusted prevalence ratios (aPRs). Health coverage and access to care were suboptimal. Less education and older age were positively associated with illness and negatively associated with HIV and tuberculosis (TB) testing. In the first study to quantitatively examine health utilization by gender identity subgroup (i.e., woman, trans or transgender, transsexual, "transformista," "travesti," and other) in Perú, TGW who identified as women were more likely to ever test for HIV (aPR = 1.49, 95% confidence interval [CI]: 1.16-1.91) and use pre-exposure prophylaxis (PrEP) (aPR = 2.36, 95% CI: 1.15-4.80). Both awareness and interest regarding PrEP were low, as was usage among those who were interested in taking PrEP. Public health efforts should be tailored to meet TGW's diverse needs, expand TB testing, bridge the gap between PrEP interest and use, and increase insurance coverage and access to trans-friendly services for improved health.
全球范围内，跨性别女性（TGW）在获得健康和医疗服务方面面临着广泛的障碍，她们感染传染病和慢性病的风险过高。然而，关于中低收入国家跨性别群体获得医疗服务的研究仍然有限，主要集中在人类免疫缺陷病毒（HIV）感染方面，并且将 TGW 视为一个同质群体进行评估。我们分析了秘鲁利马 TGW 的发病率和卫生服务利用模式，以了解健康外展和服务需求，为社区层面的干预措施提供目标和设计依据。 这项横断面研究于 2020 年 9 月至 10 月期间便利抽样调查了利马大都市的 301 名 TGW。我们报告描述性统计数据以及单变量和多变量回归模型结果，作为调整后的患病率比（aPR）。 卫生保健覆盖率和获得服务的机会不理想。教育程度较低和年龄较大与患病呈正相关，与 HIV 和结核病（TB）检测呈负相关。这是第一项在秘鲁定量研究按性别认同亚组（即女性、跨性别或 transgender、变性人、“transformista”、“travesti”和其他）划分的健康利用情况的研究，自认为是女性的 TGW 更有可能接受过 HIV 检测（aPR=1.49，95%置信区间[CI]：1.16-1.91）和使用暴露前预防（PrEP）（aPR=2.36，95% CI：1.15-4.80）。PrEP 的知晓率和兴趣都很低，有兴趣使用 PrEP 的人中实际使用率也很低。 公共卫生工作应根据 TGW 的不同需求进行调整，扩大结核病检测，缩小 PrEP 兴趣与使用之间的差距，并增加保险覆盖范围和获得对跨性别友好的服务，以改善健康状况。
