Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study

<div><p>Introduction</p><p>Discrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI). Little is known about the relationship between gender-based discrimination (GBD) and URAI with stable partners among transgender women.</p><p>Methods</p><p>This mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Respondent-driven sampling was used to recruit the study population. GBD was defined through Latent Class Analysis. Additionally, 19 semi-structured interviews with participants were transcribed and analyzed through thematic content analysis.</p><p>Results</p><p>URAI with stable partners was commonly reported (37.3%). GDB was positively associated with URAI among stable partners (OR = 6.47; IC 95%: 1.67–25.02). The analysis of the interviews illustrated how GBD impacted transgender women in diverse ways. Experiences with GBD perpetrated by the family often initiated a trajectory of economic vulnerability that led many to engage in survival sex work. The constant experience with GBD contributed to participants feeling an immense sense of trust with their stable partners, ultimately diminished their desire to use condoms. Further, the high frequency of GBD contributed to poor mental health overall, though some participants said engagement in transgender advocacy efforts provided a vital source of resilience and support.</p><p>Conclusion</p><p>Our mixed-method study capitalizes upon the strengths of diverse data sets to produce a holistic understanding of GBD and URAI with stable partners. Furthermore, by confirming the association between greater GBD and URAI, we have demonstrated how GBD can impact condom negotiation in diverse relationships.</p></div

Latent class analysis for gender-based discrimination for two classes (n = 127).

<p>Latent class analysis for gender-based discrimination for two classes (n = 127).</p

Odds ratio between gender-based discrimination and URAI with stable partners, estimated by logistic regression models (n = 116).

<p>Odds ratio between gender-based discrimination and URAI with stable partners, estimated by logistic regression models (n = 116).</p

Descriptive statistics of the study population.

<p>Descriptive statistics of the study population.</p

Criteria for comparing models with different number of classes for gender-based discrimination using latent class analysis (n = 127).

<p>Criteria for comparing models with different number of classes for gender-based discrimination using latent class analysis (n = 127).</p

Prevalence of HTLV-1 infection among males and females in Salvador, Bahia-Brazil, stratified by age in years.

<p>Prevalence of HTLV-1 infection among males and females in Salvador, Bahia-Brazil, stratified by age in years.</p

Study population and Prevalence Rate of HTLV-1 Infection according to study variables.

<p>Salvador, Northeast Brazil.</p

Crude and adjusted Odds Ratios (OR) regarding the association of HTLV-1 infection and syphilis, adjusted for sex, family income, age, years of education and HIV infection in Salvador, Northeast Brazil.

<p>Crude and adjusted Odds Ratios (OR) regarding the association of HTLV-1 infection and syphilis, adjusted for sex, family income, age, years of education and HIV infection in Salvador, Northeast Brazil.</p

Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil

<div><p>The aim of this study was to assess risk factors associated with low levels of HIV testing among MSM recruited through respondent driven sampling (RDS) in Brazil. Of 3,617 participants, 48.4% had never tested previously for HIV. A logistic model indicated that younger age, lower socioeconomic class, education, poor HIV/AIDS knowledge, no history of cruising, and having been tested during the study were characteristics independently associated with low levels of previous HIV testing. The HIV testing rate among MSM in Brazil is still low in spite of the availability of a large number services providing universal and free access to HIV/AIDS diagnosis and treatment. To respond to low utilization, the authors propose a higher priority for testing for key populations such as MSM, expanded education, expanding testing sites and a welcoming and nonjudgmental environment in health services.</p></div

Multivariate analysis (final model) of never testing for HIV among MSM in Brazil, 2009.

<p>Multivariate analysis (final model) of never testing for HIV among MSM in Brazil, 2009.</p