Factors associated with HIV viremia in transgender women and transvestites in five Brazilian capitals, 2019-2021: a multicenter study.

OBJECTIVE

To analyze factors associated with detectable HIV viremia among transgender women/transvestites (TWT) in five Brazilian capitals.

METHODS

: This was a cross-sectional study using data from a sample of TWT with HIV-positive serology and detectable viral load (VL), between 2019 and 2021. The dependent and independent variables were, respectively: viral load measurement, socioeconomic/demographic characteristics; alcohol/drug use; and self-perceived mental health. Poisson regression with robust variance was used.

RESULTS

: A total of 425 TWT tested positive for HIV and underwent VL measurement, 179 (42.0%) presented detectable viremia. Factors positively associated with detectability were: younger age (PR=2.26; 95%CI 1.13;4.51), poorer housing conditions (PR=2.72; 95%CI 1.30;5.68) and poor/very poor mental health (PR=1.70; 95%CI 1.08;2.66). The use of antiretroviral drugs was a protective factor against detectability (PR=0.29; 95%CI 0.30;0.61).

CONCLUSION

The factors associated with unsuppressed viral load highlight vulnerability related to gender identity that have a negative impact, despite the majority of participants being on antiretroviral therapy (ART).

MAIN RESULTS

People aged 20-29 who were homeless or unstable and those who reported poor or very poor mental health were more likely to have a detectable viral load. ARV drug use was a protective factor.

IMPLICATIONS FOR SERVICES

The identification of predictors for detectable viral load enables the design of appropriate strategies for monitoring and linking vulnerable people to health services, ensuring effective implementation.

PERSPECTIVES

It is necessary to develop educational strategies that take into account important social issues to improve awareness about undetectable viral load in HIV prevention among the transgender population, especially among younger people.