Department of Child Neurology, UCLA Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
AIDS Behav. 2024 Nov;28(11):3893-3907. doi: 10.1007/s10461-024-04462-4. Epub 2024 Aug 22.
Globally, transgender women (TW) face a high burden of the HIV epidemic. In Peru, HIV prevalence among TW rises at age 25, indicating a need to understand HIV vulnerability as adolescents reach adulthood. The life course of TW is often marked by abuse, discrimination and poverty fueled by transphobic stigma. Approaches to the HIV epidemic among TW and adolescents emphasize problem behaviors such as unprotected sex and substance. However, there has been a call for HIV research and interventions to understand and leverage community strengths. This qualitative study utilized a transgender-oriented, strength-based, intersectional and feminist approach to understand the strengths and protective health behaviors among 17 transgender adolescents and young women (TAYW) age 16-24 in Lima, Peru. Most participants re-located to Lima from the Amazon due to familial rejection, and engaged in obligatory sex work. TAYW demonstrated self-knowledge, motivation for education, efforts to secure employment, strong community networks, legal advocacy, avoiding problem substance use, HIV knowledge and condom use. However, strengths were impeded by multi-level barriers such as familial physical abuse, educational discrimination, and sexual assault which led to increased HIV vulnerability. We created a conceptual model of the "cycle" of HIV to describe the limits of personal responsibility within a vulnerable community denied access to family, education, employment and human rights. We recommend researchers, clinicians and public health workers follow the lead of TAYW at the frontlines of the HIV epidemic, and support beloved communities and enabling environments which may permit protective behaviors to mitigate HIV vulnerability.
在全球范围内，跨性别女性（TW）面临着艾滋病流行的沉重负担。在秘鲁，TW 的艾滋病感染率在 25 岁时上升，这表明需要了解青少年进入成年期时的艾滋病易感染性。TW 的生活轨迹通常以受虐待、歧视和仇跨性别偏见导致的贫困为特征。针对 TW 和青少年艾滋病流行的方法强调了无保护性行为和药物滥用等问题行为。然而，人们呼吁进行艾滋病研究和干预，以了解和利用社区优势。这项定性研究采用了以跨性别为导向、以优势为基础、交叉和女权主义的方法，以了解秘鲁利马 16-24 岁的 17 名跨性别青少年和年轻女性（TAYW）的优势和保护健康行为。大多数参与者因家庭排斥而从亚马逊地区搬到利马，并从事强制性性工作。TAYW 表现出自知之明、教育动机、努力获得就业、强大的社区网络、法律倡导、避免问题药物使用、艾滋病知识和使用避孕套。然而，优势受到多层次障碍的阻碍，如家庭身体虐待、教育歧视和性侵犯，这导致艾滋病易感性增加。我们创建了一个艾滋病“循环”的概念模型，以描述在一个被剥夺家庭、教育、就业和人权的弱势社区中，个人责任的局限性。我们建议研究人员、临床医生和公共卫生工作者跟随处于艾滋病流行前线的 TAYW 的领导，并支持心爱的社区和有利的环境，这些环境可能允许保护性行为来减轻艾滋病易感性。
