Background
Transgender women (TGW) have an increased risk for HIV due to social exclusion, barriers to access to health care, discrimination, and exposure to higher-risk contexts such as sex work. In fact, there is a lack of studies assessing the dynamics of the HIV epidemic among TGW in rural cities. This is a cross-sectional study that aimed to estimate the prevalence and factors associated with HIV acquisition and compared the characteristics among TGW in the state capital vs. rural towns of Goiás, which are regions far from the HIV epicenter in Brazil.
Methods
From 2018 to 2019 a total of 440 transgender women were recruited, 285 in the capital of Goiás (Goiânia) and 155 in the state’s rural towns (Jataí and Itumbiara). All participants were interviewed about sociodemographic characteristics and sexual risk behaviors. The blood samples were tested by rapid test (Bioclin HIV Tri line, Quibasa, BH, Brazil; R DPP® HIV 1/2, Bio-Manguinhos, RJ, Brazil) and retested by ELISA (Genscreen™ ULTRA HIV Ag-Ab, Bio-Rad, Marnes-la-Coquette, France). Samples positive in both tests were considered positive. Prevalence was estimated with a 95% confidence interval. We performed bivariate and multiple Poisson regression analyses with 95% confidence intervals (CI).
Results
TGW from the state capital reported higher monthly income, more sexual partners, more engagement in sex work, more group sex, less insertive anal sex, and more sex with men and women compared to TGW who lived in rural towns. Those in rural towns reported more sex with men only (p< 0.05). HIV prevalence was 32.9% (95% CI: 27.6% – 38.6%) in the capital and 33.8% (95% CI: 26.7-41.6) in the rural towns, some participants were unaware of their serological status. Among the TGW from the capital, STI history (self-reported) was associated with HIV (Adjusted Prevalence Rate [APR] 1.5; 95% CI: 1.04-2.1), while among those from rural towns, STI (self-reported) was associated with HIV (APR: 2.2; 95% CI: 1.3-3.8) as well as group sex (APR: 2.5; 95% CI: 1.1-5.6).
Conclusions
Despite a higher proportion of risk behaviors found among TGW in the capital vs. rural cities, the high burden of HIV among TGW was similar among the two groups. STI history was a common factor associated with HIV in both groups. Therefore, health interventions supported by governmental public policies are urgently needed to mitigate the HIV epidemic in this key population in both large metropolitan and smaller cities in central Brazil.