Camila-Bolívar Maria, Gomez-Peñaloza Sheilla Andrea, Camargo-Plazas Pilar, Peralta-Ardila María Del Pilar, Mueses-Marín Héctor F, Alvarado-Llano Beatriz, Martínez-Cajas Jorge L
Department of Public Health and Epidemiology, Pontificia Universidad Javeriana Cali, Cali, Colombia.
Corporación de Lucha Contra el Sida, Cali, Colombia.
PLOS Glob Public Health. 2023 Sep 27;3(9):e0001395. doi: 10.1371/journal.pgph.0001395. eCollection 2023.
Transgender women [TGW] in Colombia are disproportionately affected by HIV due to their low sociodemographic conditions, varied risk behaviours, difficulty accessing health services, and discrimination. Offering pre-exposure prophylaxis [PrEP] as part of a combination of prevention strategies is an appropriate option for this population to reduce their risk of HIV infection. However, little is known about how to implement a PrEP program for TGW in Colombia. Between June and October 2020, we conducted individual interviews with 16 TGW from four different cities in Colombia. The interviews assessed contextual influences, knowledge, skills, perceptions, and beliefs. We used qualitative thematic analysis to identify themes and the Capability, Opportunity, Motivation, and Behavior framework to further delineate barriers and possible interventions. After delineating the main themes across the three subdomains of the model, nine barriers were identified: one related to capability, knowledge, and perception of PrEP; six related to opportunity, which includes, family relations, sexual work environment, stable partner relations, interactions with healthcare workers, health service provision, and community interactions and opportunities; and two related to motivation, mental health, and concerns about medication side effects. Mapping barriers with interventions generated the following intervention functions: education, training, enablement, and environmental structure; and the following policy functions: communication/marketing, legislation, and changes in service provision. Examples of possible interventions are presented and discussed.
哥伦比亚的跨性别女性（TGW）由于社会人口状况不佳、风险行为多样、获得医疗服务困难以及遭受歧视，在艾滋病毒感染方面受到的影响尤为严重。将暴露前预防（PrEP）作为预防策略组合的一部分提供给这一人群，是降低其艾滋病毒感染风险的合适选择。然而，对于如何在哥伦比亚为跨性别女性实施PrEP项目，人们知之甚少。2020年6月至10月期间，我们对来自哥伦比亚四个不同城市的16名跨性别女性进行了个人访谈。访谈评估了背景影响、知识、技能、认知和信念。我们采用定性主题分析来确定主题，并运用能力、机会、动机和行为框架进一步勾勒障碍及可能的干预措施。在勾勒出该模型三个子领域的主要主题后，确定了九个障碍：一个与PrEP的能力、知识和认知有关；六个与机会有关，包括家庭关系、性工作环境、稳定伴侣关系、与医护人员的互动、医疗服务提供以及社区互动和机会；还有两个与动机、心理健康以及对药物副作用的担忧有关。将障碍与干预措施进行匹配，产生了以下干预功能：教育、培训、赋能和环境构建；以及以下政策功能：沟通/营销、立法和服务提供方面的变革。文中给出并讨论了可能的干预措施示例。
