HIV Risk and Psychosocial Health Among Transgender Women in Peru

项目摘要 在全球范围内，变性妇女（TW）因艾滋病毒感染而负担沉重，估计有19.1% 流行率（荟萃分析），相对于普通人群，艾滋病毒感染几率增加近50倍 国际吧在秘鲁，TW是受影响最严重的人口，首都的艾滋病毒感染率为29.8%-48.8% 在利马，艾滋病毒感染率急剧上升，25岁及以上的人感染率急剧上升。所以年轻 16-24岁的跨性别女性（YTW）是一个非常重要的，但研究不足的群体， 艾滋病毒的主要预防工作。人们对精神健康和心理社会脆弱性知之甚少 (e.g.,抑郁症、创伤后应激障碍、物质使用障碍、基于性别的暴力） YTW在秘鲁的经历。伴随的精神健康和其他心理社会健康状况导致 在青春期后期和青年期的关键发育期， 协同增强秘鲁YTW感染HIV风险，并影响生物行为HIV预防目标， 保护性行为、无菌针头注射做法和暴露前预防（PrEP）摄入。遵循一 心理社会综合症框架和生命过程健康发展模型，本研究的目的是： 描述油麻地爱滋病病毒感染及相关性病合并感染的流行率、分布情况及相关因素 秘鲁利马16-24岁的人，和B）评估同时发生的心理健康和社会心理状况 （脆弱性和传染性）及其对艾滋病毒传播风险的影响。在目标1中，我们将 形成性的深入访谈，以了解艾滋病毒风险的发展和心理社会背景， 秘鲁。我们还将收集关于基于社交网络的可接受性和障碍/促进因素的数据。 招聘方法。在目标2中，我们将描述艾滋病毒和性传播感染的流行、分布和相关因素， 合并感染和多种与耻辱有关的健康状况（例如，抑郁症，创伤后应激障碍，物质使用障碍， 欺凌，家庭拒绝）的样本中的400 YTW通过社会网络为基础的方法招募。我们将 描述招募的可接受性和招募率，为未来的艾滋病毒预防试验提供信息。在目标3中，我们 测试几种统计方法来模拟YTW中同时发生的综合性风险因素，同时 考虑：总体状况与艾滋病毒风险相关的程度; 条件相互作用，加剧艾滋病毒的风险。在秘鲁，减少变性人感染艾滋病毒的差距将 需要达到YTW年龄16-24岁的早期艾滋病毒预防。这项研究将增加科学知识 多种精神健康和心理社会交叉流行病加剧了艾滋病毒风险和性传播感染共病， YTW。研究结果将为生物行为艾滋病预防干预措施的设计和实施提供信息， YTW在秘鲁，如那些针对发展的具体集群的耻辱相关的条件， 最大限度地发挥对艾滋病毒流行的影响，减少全球TW的艾滋病毒负担。调查结果也可能是 用于为美国拉丁裔/西班牙裔YTW的早期艾滋病毒预防工作提供信息。

Project Summary Globally, transgender women (TW) are devastatingly burdened by HIV infection with an estimated 19.1% prevalence (meta-analysis), a nearly 50-fold increased odds of HIV relative to the general population worldwide. In Peru, TW are the most affected population, with 29.8%-48.8% HIV prevalence in the capital city of Lima, and steep increases in HIV infection rates in those ages 25 years and older. Therefore, young transgender women (YTW) ages 16-24 years constitute a critically important, yet understudied, group for early primary HIV prevention efforts. Very little is known about the mental health and psychosocial vulnerabilities (e.g., depression, posttraumatic stress disorder [PTSD], substance use disorder, gender-based violence) experienced by YTW in Peru. Concomitant mental health and other psychosocial health conditions resulting from stigma, and during the critical developmental period of late adolescence and young adulthood, may synergistically potentiate risk for HIV for YTW in Peru, and influence biobehavioral HIV prevention targets like protected sex, sterile needle injecting practices, and pre-exposure prophylaxis (PrEP) uptake. Guided by a psychosocial syndemics framework and Lifecourse Health Development model, the goal of this study is to: a) characterize the prevalence, distribution, and correlates of HIV infection and related STI co-infections in YTW ages 16-24 years in Lima, Peru, and b) assess co-occurring mental health and psychosocial conditions (vulnerabilities and resiliencies) and their influence on HIV transmission risk. In Aim 1, we will conduct formative in-depth interviews to understand developmental and psychosocial contexts of HIV risk for YTW in Peru. We will also gather data on perceived acceptability and barriers/ facilitators to social network-based recruitment methods. In Aim 2, we will characterize the prevalence, distribution, and correlates of HIV and STI- coinfections, and multiple stigma-related health conditions (e.g., depression, PTSD, substance use disorder, bullying, family rejection) in a sample of 400 YTW recruited via social network-based methods. We will characterize the acceptability and rates of recruitment to inform future HIV prevention trials. In Aim 3, we will test several statistical approaches to modeling co-occurring syndemic risk factors in YTW, and simultaneously consider: the extent to which conditions in the aggregate are associated with HIV risk; the extent to which conditions interact to intensify HIV risk. Reducing HIV disparities for transgender populations in Peru will require reaching YTW ages 16-24 years for early HIV prevention. This study will increase scientific knowledge of the multiple mental health and psychosocial intersecting epidemics fueling HIV risk and STI co-morbidities in YTW. Findings will inform the design and implementation of biobehavioral HIV prevention interventions for YTW in Peru, such as those which target developmentally-specific clusters of stigma-related conditions, to maximize impact on the HIV epidemic and decrease HIV burden among TW globally. Findings can also be used to inform early HIV prevention efforts for Latina/ Hispanic YTW in the U.S.