HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.
HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.
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DOI：
10.1371/journal.pmed.1002422
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发表时间：
2017-11
期刊：
影响因子：
15.8
通讯作者：
Baral S
中科院分区：
文献类型：
--
作者：
Poteat T;Ackerman B;Diouf D;Ceesay N;Mothopeng T;Odette KZ;Kouanda S;Ouedraogo HG;Simplice A;Kouame A;Mnisi Z;Trapence G;van der Merwe LLA;Jumbe V;Baral S
撒哈拉以南非洲承担了全球艾滋病毒负担的三分之二以上;然而，该地区变性妇女的数据很少。世界各地的跨性别妇女都面临着感染艾滋病毒的严重脆弱性。这项分析旨在评估8个撒哈拉以南非洲国家跨性别女性与顺性别（非跨性别）男男性行为者（cis-MSM）相比的艾滋病毒感染率以及艾滋病毒感染的心理社会和行为驱动因素。受试者驱动的抽样针对cis-MSM进行招募。数据收集在8个国家的14个研究中心进行：布基纳法索（2013年1月至8月），科特迪瓦（2015年3月至2016年2月），冈比亚（2011年7月至12月），莱索托（2014年2月至9月），马拉维（2011年7月至2012年3月）、塞内加尔（2015年2月至11月）、斯威士兰（2011年8月至12月）和多哥（2013年1月至6月）。调查收集了关于性取向、性别认同、耻辱、心理健康、性行为和艾滋病毒检测的信息。进行了艾滋病毒快速检测。数据合并，混合效应逻辑回归模型被用来估计性别认同和艾滋病毒感染之间的关系。在4，586名出生时被指定为男性的参与者中，937名（20%）被确定为变性人或女性，3，649名为顺式MSM。研究参与者的平均年龄约为24岁，跨性别参与者和顺-MSM之间没有差异。与cis-MSM参与者相比，跨性别女性更容易受到家庭排斥（比值比[OR] 1.75，95% CI 1.42-2.16，p < 0.001），强奸（OR 1.95，95%CI 1.63-2.36，p < 0.001）和抑郁症状（OR 1.30，95%CI 1.12-1.52，p < 0.001）。跨性别女性更有可能在过去12个月内报告无安全套接受肛交（OR 2.44，95% CI 2.05-2.90，p < 0.001），目前携带艾滋病毒（OR 1.81，95% CI 1.49-2.19，p < 0.001）。跨性别妇女的总体艾滋病毒感染率为25%（235/926），顺式MSM为14%（505/3，594）。当调整年龄，无安全套接受肛交，抑郁，人际耻辱，执法耻辱和暴力，以及性别与无安全套接受肛交的相互作用时，跨性别女性感染艾滋病毒的几率是顺式MSM的2.2倍（95% CI 1.65-2.87，p < 0.001）。该研究的局限性包括为顺式MSM量身定制的抽样策略以及将数据集与不相同的调查工具合并。在撒哈拉以南非洲的这项研究中，我们发现跨性别女性和顺-MSM之间的艾滋病毒负担和耻辱感不同，这表明需要在艾滋病毒研究和计划中解决性别多样性问题。在对非洲国家数据的横断面分析中，Tonia Poteat及其同事报告了跨性别女性和男性同性性行为者感染和艾滋病毒流行的风险因素。撒哈拉以南非洲包括艾滋病毒流行最普遍的国家。世界各地的跨性别妇女艾滋病毒预防和治疗需求未得到满足;然而，对撒哈拉以南非洲地区跨性别妇女具体需求的研究有限。我们合并了艾滋病毒检测结果和调查数据，这些数据最初集中在撒哈拉以南非洲8个国家的男同性恋者和其他与男性发生性关系的男性（MSM），然后专门评估了跨性别女性与顺性别MSM。我们在4，586名样本中确定了937名跨性别女性。我们发现，跨性别女性比顺性别男男性接触者更有可能检测出艾滋病毒阳性，并报告有耻辱感、抑郁症状和无避孕套性行为的经历。撒哈拉以南非洲的性别认同与其他区域一样复杂。这些数据突出了撒哈拉以南非洲艾滋病毒预防和治疗计划的本质主义性别二元框架的局限性。在撒哈拉以南非洲推进艾滋病毒的预防和治疗需要特别研究针对变性妇女的方案的适当内容和实施情况。
Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63–2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs. In a cross-sectional analysis of data from African countries, Tonia Poteat and colleagues report on risk factors for infection and HIV prevalence in transgender women and men who have sex with men. Sub-Saharan Africa includes countries with the most broadly generalized HIV epidemics. Transgender women have unmet HIV prevention and treatment needs around the world; however, study of their specific needs across sub-Saharan Africa has been limited. We merged HIV test results and survey data from studies initially focused on gay men and other men who have sex with men (MSM) in 8 countries in sub-Saharan Africa, then specifically assessed transgender women separately from cisgender MSM. We identified 937 transgender women among the total sample of 4,586 individuals. We found that transgender women were more likely than cisgender MSM to test positive for HIV as well as report experiences of stigma, depressive symptoms, and condomless sex. Gender identities are as complex across sub-Saharan Africa as they are in other regions. These data highlight the limitations of an essentialist gender binary framework for HIV prevention and treatment programs in sub-Saharan Africa. Advancing HIV prevention and treatment in sub-Saharan Africa necessitates specifically studying the appropriate content and implementation of programs that reach transgender women.
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DOI：
10.1037/cbs0000069
发表时间：
2017-04-01
影响因子：
2.5
作者：
Flora, David B.;Flake, Jessica K.
通讯作者：
Flake, Jessica K.
DOI：
10.1016/s2352-3018(15)00206-4
发表时间：
2015-12
期刊：
The lancet. HIV
影响因子：
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作者：
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iPrEx investigators
影响因子：
4.4
作者：
Guadamuz, Thomas E.;Wimonsate, Wipas;Varangrat, Anchalee;Phanuphak, Praphan;Jommaroeng, Rapeepun;McNicholl, Janet M.;Mock, Philip A.;Tappero, Jordan W.;van Griensven, Frits
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van Griensven, Frits
影响因子：
6
作者：
Baral, Stefan D.;Ketende, Sosthenes;Adams, Darrin
通讯作者：
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影响因子：
7.7
作者：
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通讯作者：
Boily MC