Risk factors associated with resistance to HIV testing among transwomen in Brazil

Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419–7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996–15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310–4.339), experience of discrimination (OR = 3.962; CI = 1.540–10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118–6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required.

[1]  W. Bockting,et al.  HIV Risk Behaviors in the U.S. Transgender Population: Prevalence and Predictors in a Large Internet Sample , 2014, Journal of homosexuality.

[2]  O. Tarasenko,et al.  2014 European Guideline on HIV testing , 2014, International journal of STD & AIDS.

[3]  G. Marks,et al.  Homophobia is Associated with Sexual Behavior that Increases Risk of Acquiring and Transmitting HIV Infection Among Black Men Who Have Sex with Men , 2013, AIDS and Behavior.

[4]  E. Coleman,et al.  Stigma, mental health, and resilience in an online sample of the US transgender population. , 2013, American journal of public health.

[5]  C. Kendall,et al.  Travestis, an unexplored population at risk of HIV in a large metropolis of northeast Brazil: A respondent-driven sampling survey , 2013, AIDS care.

[6]  R. Bunnell,et al.  HIV Testing: Current Practice and Future Directions , 2013, Current HIV/AIDS Reports.

[7]  C. Beyrer,et al.  Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. , 2013, The Lancet. Infectious diseases.

[8]  S. Selph,et al.  Screening for HIV: Systematic Review to Update the 2005 U.S. Preventive Services Task Force Recommendation , 2012, Annals of Internal Medicine.

[9]  Robb Travers,et al.  High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey , 2012, BMC Public Health.

[10]  P. Phanuphak,et al.  HIV Prevalence, Risk Behavior, Hormone Use and Surgical History Among Transgender Persons in Thailand , 2011, AIDS and Behavior.

[11]  S. Lautenschlager,et al.  European guideline for the management of genital herpes, 2010 , 2011, International journal of STD & AIDS.

[12]  Stanley Luchters,et al.  Barriers to HIV testing in Europe: a systematic review. , 2010, European journal of public health.

[13]  R. Melendez,et al.  HIV Prevention and Primary Care for Transgender Women in a Community‐Based Clinic , 2009, The Journal of the Association of Nurses in AIDS Care : JANAC.

[14]  A. Danoff,et al.  Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. , 2009, American journal of public health.

[15]  Luiz Gonzaga Godoi Trigo Travesti: prostituição, sexo, gênero e cultura no Brasil , 2008 .

[16]  T. Rhodes,et al.  Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study , 2008, BMJ : British Medical Journal.

[17]  V. Romano As Travestis no Programa Saúde da Família da Lapa Transvestites in the Family Health Program of Lapa , 2008 .

[18]  D. Heckathorn,et al.  HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons. , 2008, American journal of public health.

[19]  Jamison Green,et al.  Utilization of Health Care Among Female-to-Male Transgender Individuals in the United States , 2008, Journal of homosexuality.

[20]  K. Underhill,et al.  Sex Work and HIV Status Among Transgender Women: Systematic Review and Meta-Analysis , 2008, Journal of acquired immune deficiency syndromes.

[21]  Lisa G. Johnston,et al.  An Empirical Comparison of Respondent-driven Sampling, Time Location Sampling, and Snowball Sampling for Behavioral Surveillance in Men Who Have Sex with Men, Fortaleza, Brazil , 2008, AIDS and Behavior.

[22]  N. Kiviat,et al.  HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers , 2007, Sexually Transmitted Infections.

[23]  E. Lombardi Substance use treatment experiences of transgender/transsexual men and women. , 2007, Journal of LGBT health research.

[24]  G. Marks,et al.  Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA , 2006, AIDS.

[25]  G. Kenagy Transgender health: findings from two needs assessment studies in Philadelphia. , 2005, Health & social work.

[26]  Afonso Dinis Costa Passos,et al.  Fatores de risco para doenças sexualmente transmissíveis entre prostitutas e travestis de Ribeirão Preto (SP), Brasil , 2004 .

[27]  W. Bockting,et al.  Patient Satisfaction with Transgender Health Services , 2004, Journal of sex & marital therapy.

[28]  R. Hellman,et al.  Satisfaction with mental health services among sexual minorities with major mental illness. , 2001, American journal of public health.

[29]  E. Paolucci,et al.  A Meta-Analysis of the Published Research on the Effects of Child Sexual Abuse , 2001, The Journal of psychology.

[30]  L. Bensley,et al.  Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. , 2000, American journal of preventive medicine.

[31]  Douglas D. Heckathorn,et al.  Respondent-driven sampling : A new approach to the study of hidden populations , 1997 .

[32]  M. Ot The Second National AIDS Research Forum. , 1995 .

[33]  J. D. De Santis HIV infection risk factors among male-to-female transgender persons: a review of the literature. , 2009, The Journal of the Association of Nurses in AIDS Care : JANAC.

[34]  T. Finlayson,et al.  Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review , 2007, AIDS and Behavior.

[35]  Maristela Monteiro,et al.  AUDIT - The alcohol use disorders identification test: guidelines for use in primary care. , 2001 .

[36]  O. Monzon The Second National AIDS Research Forum. , 1995, NASPCP newsletter. National AIDS/STD Prevention and Control Program.