The Transnational Cohort: global HIV epidemiology and prevention research for transwomen.

 描述（由申请人提供）：跨性别妇女在全球范围内承担着不成比例的艾滋病毒负担，但发病率很少被测量，获得感染的决定因素也是未知的。没有证据表明对变性妇女采取有效的艾滋病毒预防干预措施。我们项目的目标是为跨性别妇女的艾滋病毒流行病学和预防研究创建一个国际平台，获得艾滋病毒发病率的基准，并确定感染的因果因素。我们提出了一个队列研究的1,100跨女性在旧金山弗朗西斯科，美国和圣保罗，巴西的能力准备纵向研究。该队列将测量艾滋病毒的发病率和测试假设艾滋病毒收购有关的社会和生物医学性别转变事件和组件的性别肯定，行为生态和少数民族压力模型。与此同时，在世界上最大的国家中国，以及艾滋病疫情最严重的撒哈拉以南非洲，人们对变性妇女知之甚少。关于这些地区变性妇女的基本流行病学研究早该进行。因此，我们还建议在中国南京的250 transwomen的横断面调查和形成性评估的transwomen在温得和克，纳米比亚。除了获得中国跨性别妇女艾滋病流行率的第一个估计值和撒哈拉以南非洲跨性别妇女的第一个重点研究外，我们还将为未来纳入队列做好准备。我们目前提案的具体目标是：1）在旧金山弗朗西斯科和圣保罗建立一个以人口为基础的跨性别妇女队列，以衡量艾滋病毒发病率; 2）检验关于社会和生物医学性别转变事件是跨性别妇女感染艾滋病毒的因果因素的假设; 3）在中国和撒哈拉以南非洲启动跨性别妇女艾滋病毒预防研究。我们将使用应答者驱动抽样（RDS）进行招募，以近似基于人群的样本，从而获得高外部效度。将使用社交媒体和移动的以及基于网络的技术来提高队列保留率，以获得高内部效度。艾滋病毒只是变性妇女经历的健康差距之一。变性妇女患多种心理健康疾病的风险增加，人们对性别转换程序对非传染性疾病的影响知之甚少。该项目最终将促成一项国际合作，以开展严格的艾滋病毒预防研究，包括事件终点和变性妇女健康问题辅助研究的基础设施。

 DESCRIPTION (provided by applicant): Transwomen bear a disproportionate burden of HIV worldwide, yet incidence is seldom measured and the determinants of acquiring infection are unknown. There is no HIV prevention intervention for transwomen with evidence of efficacy. Our project's goals are to create an international platform for HIV epidemiology and prevention research for transwomen, obtain benchmarks for HIV incidence, and characterize causal factors for infection. We propose a cohort study of 1,100 transwomen in San Francisco, USA and São Paulo, Brazil where capacities are ready for longitudinal research. The cohort will measure HIV incidence and test hypotheses on HIV acquisition related to social and biomedical gender transition events and components of the Gender Affirmation, Behavioral Ecological, and Minority Stress models. Meanwhile, little is known about transwomen in China, the world's largest country, or sub- Saharan Africa, where the HIV epidemic is most severe. Basic epidemiological research on transwomen in these regions is overdue. We therefore also propose a cross-sectional survey of 250 transwomen in Nanjing, China and a formative assessment of transwomen in Windhoek, Namibia. In addition to obtaining the first estimates of HIV prevalence among transwomen in China and the first focused study of transwomen in sub-Saharan Africa, we will prepare these sites for future inclusion in the cohort. Our specific aims for the current proposal are: 1) to establish a population-based cohort of transwomen in San Francisco and São Paulo to measure HIV incidence; 2) to test hypotheses on social and biomedical gender transition events as causal factors in HIV acquisition among transwomen; 3) to initiate HIV prevention research for transwomen in China and sub-Saharan Africa. We will use respondent-driven sampling (RDS) for recruitment in order to approximate population-based samples for high external validity. Social media and mobile and web-based technologies will be used to increase cohort retention for high internal validity. HIV is only one health disparity experienced by transwomen. Transwomen are at increased risk for multiple mental health disorders and little is known about the impact of gender transition procedures on non-communicable diseases. The project will culminate in an international collaborative for rigorous HIV prevention research with incident endpoints and an infrastructure for ancillary studies on transwomen health issues.