Contexto de vulnerabilidade de travestis e sua associação com a não realização do teste anti-HIV

Abstract

Introduction: Transwomen (travesti) present various factors which make them vulnerable to HIV. However commonly, transwomen do not test for HIV. The same factors which increase HIV vulnerability could act as barriers to HIV testing. Aim: To characterize the contexts of vulnerability to HIV among tranwomen in Fortaleza/CE, so as to identify those factors associated with not testing. Methodology: We carried out an epidemiological cross-sectional survey among 304 transwomen. We included transwomen aged 14 or older who stated that had oral or anal sex with men during the past 12 months. We used the Respondent Driving Sampling (RDS) method to collect data. We analyzed our data using Respondent Driven Sampling Analysis Tool version 5.6 (RDSAT) and the Statistical Package for the Social Sciences version 13.0 (SPSS). Our analysis plan is descriptive and analytical (bivariate and multivariate regression). Results: The individual context of vulnerability was characterized by risky behaviors and sexual practices, such as no condom use at last sex (29.9%) and prostitution (83.5%); lack of information about STDs (21.7%) and HIV (29.5%); and alcohol abuse (49.0%). The social context of vulnerability included low income (34.3%), with a great number of transwomen in classes D and E (39.0%), and a history of discrimination (87.3%). In the context of the programmatic vulnerability, taking part in activities organized by NGOs was more relevant than use of the public health service (83.8% vs. 34.2%) for testing. Sixty-eight per cent (68.0%) of transwomen had never tested. The factors strongly associated with not testing were: first sexual relation under the age of 10 (OR = 6.760), the use of illegal drugs during the sex (OR = 2.384), being under 18 years old (OR = 4.221), suffering discrimination (OR = 3.962) and distrusting the confidentiality of the test result (OR = 3.763). Conclusion: Transwomen are involved in multiple contexts of vulnerability to HIV much more complex than other groups of men who have sex with men. Nevertheless, they avoid HIV testing. Therefore, new strategies for HIV prevention must be developed. Transwomen must be encouraged to test, through programs that address the special vulnerabilities of this group. Such actions may reduce the number of new infections and precocious HIV-positive diagnoses.