Background
In Brazil, transgender women (TGW) face a disproportionately high burden of HIV. Research on the patterns of the HIV epidemic in TGW is still lacking in Midwest Brazil. We aimed to evaluate the HIV prevalence and proportion of recent HIV acquisition and to explore factors associated with recent HIV acquisition among TGW from Goiás, Brazil.
Methods
We included TGW aged 16-59 from three cities in Goiás, Brazil: Goiânia, Itumbiara, and Jataí. Participants were recruited between Apr-2018 to Nov-2019 using respondent-driven sampling (RDS). HIV testing followed the Brazilian algorithm and the Maxim HIV-1 Limiting Antigen Avidity EIA (LAg) was used to identify recent HIV acquisition in plasma samples. We compared study participants’ characteristics using Pearson’s chi-square and Fisher’s test for categorical variables and the Wilcoxon test for continuous variables: (1) recent vs. longstanding HIV acquisition and (2) recent vs. HIV-negative. We used logistic regression models to assess factors associated with recent HIV acquisition among participants at risk of HIV infection (excluding those with longstanding HIV acquisition).
Results
We enrolled 440 TGW: 285 in Goiânia, 74 in Itumbiara, and 81 in Jataí; the median age was 25 years (IQR: 21-30), 312 (71.2%) self-identified as Black, 269 (61.1%) completed secondary school; none of the TGW were on PrEP. From 143 TGW who tested positive for HIV (prevalence: 33.2%), 51 reported current ARV use and were excluded from recency analysis; 87/92 participants (94.6%) had available plasma samples for LAg testing, of which 44 (50.6%) had recently acquired HIV. TGW with recent HIV acquisitions were older and more affected by STI (sexually transmitted infections) than those with longstanding HIV (p=0.041 and p=0.024, respectively) (Table). Logistic regression analysis showed a borderline association between older age and greater odds of recent HIV acquisition (OR: 1.03 [95%CI:0.99-1.07], per 1-year increase, p=0.08).
Conclusions
The very high levels of HIV prevalence and recent HIV acquisition among TGW in Midwest Brazil highlight the significant burden of the HIV epidemic and STI in this population, despite the availability of public health prevention strategies. Older TGWs may have a lower perception of risk, leading to behaviors that increase the odds of acquiring HIV. It is crucial to address these gaps to improve targeted interventions and care for TGW, including increasing PrEP access, especially in regions where their vulnerability to HIV is high.