HIV Risk and Psychosocial Health Among Transgender Women in Peru

项目摘要 在全球范围内，变性人妇女(TW)因感染艾滋病毒而承受着毁灭性的负担，估计有19.1% 流行率(荟萃分析)，相对于普通人群，艾滋病毒的患病几率增加了近50倍 全世界。在秘鲁，TW是受影响最严重的人群，首都的艾滋病毒感染率为29.8%-48.8% 在利马，艾滋病毒感染率在25岁及以上人群中急剧上升。因此，年轻的 16-24岁的变性人妇女(YTW)是一个极其重要但尚未得到充分研究的早期群体 初级艾滋病毒预防工作。人们对精神健康和心理社会脆弱性知之甚少 (例如，抑郁症、创伤后应激障碍、物质使用障碍、基于性别的暴力) YTW在秘鲁经历的。随之而来的心理健康和其他心理社会健康状况 在青春期后期和青春期的关键发育期，可能 协同增强秘鲁YTW的艾滋病毒风险，并影响生物行为艾滋病毒预防目标，如 保护性行为、无菌针头注射做法和暴露前预防(PrEP)吸收。由一名 心理社会综合体框架和生命过程健康发展模式，本研究的目标是：a) 描述青瓦台地区HIV感染和相关STI混合感染的流行、分布和相关因素 秘鲁利马16-24岁的青少年，以及b)评估共同发生的心理健康和心理社会状况 (脆弱性和复原力)及其对艾滋病毒传播风险的影响。在目标1中，我们将进行 形成性深度访谈，以了解青瓦台妇女艾滋病风险的发育和心理社会背景 秘鲁。我们还将收集有关社交网络的感知接受度和障碍/促进者的数据 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、分布和相互关系。 混合感染和多种与耻辱相关的健康状况(例如，抑郁症、创伤后应激障碍、药物使用障碍、 欺凌、家庭拒绝)通过基于社交网络的方法招募了400名YTW。我们会 描述招募的可接受性和比率，以便为未来的艾滋病毒预防试验提供信息。在《目标3》中，我们将 在YTW中测试几种对共生风险因素进行建模的统计方法，并同时 考虑：总体情况与艾滋病毒风险相关的程度； 各种情况相互作用，加剧了艾滋病毒的风险。减少秘鲁变性人之间的艾滋病毒差距将 要求达到16-24岁的YTW，以便及早预防艾滋病毒。这项研究将增加科学知识 多种心理健康和心理社会交叉流行加剧了艾滋病毒风险和性传播感染的并存 YTW。研究结果将为设计和实施生物行为艾滋病毒预防干预措施提供指导 秘鲁的YTW，例如针对与耻辱相关的发育特定群组的那些，以 最大限度地减少对艾滋病毒流行的影响，并在全球范围内减少TW的艾滋病毒负担。调查结果也可以是 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.