1 / 16

Syndemic Evaluation in Brazilian Transgender Women Using PrEP for HIV Prevention: Preliminary Findings

This study evaluates the prevalence of syndemics and associated factors in transgender women (TGW) screened for a PrEP demonstration project in Brazil. Syndemics are clusters of health/social conditions increasing health problems in TGW, a key HIV population. The study assessed mental health, substance abuse, sexual risk behaviors, and vulnerabilities in 143 TGW. Results show a high syndemic prevalence (49.7%), more common in non-white individuals with histories of violence and high impulsivity. Post-traumatic stress disorder may be linked to violence and anxiety symptoms. The research aims to understand factors contributing to syndemics in TGW for improved intervention strategies.

williamperry
Download Presentation

Syndemic Evaluation in Brazilian Transgender Women Using PrEP for HIV Prevention: Preliminary Findings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evaluationofsyndemics in transgenderwomen (TGW) usingpre-exposureprophylaxis (PrEP) for HIV prevention: preliminaryfindings • Michelle Ramos¹, Emilia Jalil¹, Flavia Lessa¹, Cristiane Castro¹, Cristina Jalil¹, Eduardo Carvalheira¹, Laylla Monteiro¹, Cléo Souza¹, Biancka Fernandes¹, Luciana Kamel¹, Ronaldo I. Moreira¹, Vinicius Pacheco¹, Valdilea Veloso¹, Beatriz Grinsztejn¹, Raquel B. De Boni¹. • 1 LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI) • FIOCRUZ, Rio de Janeiro, Brazil Share your thoughts on this presentation with #IAS2019

  2. BACKGROUND • Whatissyndemic? • The cluster of ≥2 health/social conditions that interact and increase the occurrence of other health problems. • Transgenderwomen (TGW) • Key- population for HIV infection • 19.1% of HIV prevalenceworldwide ² • Brazil : 31.2% populationestimates by Transcender³, 30.0% by DIVAS (12 Brazilian cities) • Limitedacademicliteratureon syndemics among TGW • PrEP : Availableat no costat Brazilian publichealth system (SUS) since 2017 ¹Singer M, 1994;²Baral et al., 2013; ³ GRINSZTEJN et al., 2018; (BASTOS et al., 2018)

  3. OBJECTIVE • To assess syndemics prevalence and its associated factors among TGW screened for the PrEParadas Study – first Brazilian trans-specific PrEP demonstration project (initial primary findings presented at IAS 2019 session: TUAC0302 – Start stop restart: Supporting effective PrEP use)

  4. METHODS • Secondary cross-sectional analysis of PrEParadas study • Inclusioncriteria for PrEParadas:beingTGW, living at Rio de Janeiro ormetropolitanarea, 18+ years, atrisk for HIV infection • All TGW withvalidresults for the primaryoutomesatscreeningwereincluded in thisanalysis • Data collection at screening visit • Measures • OUTCOME: Syndemic • Standardized and validated questionnaires screening for: • Polysubstance use (ASSIST)¹ • Binge drinking² • Depression(PHQ-9)³ • Sexual compulsive behavior (SCB) • Intimate partner violence (IPV) Syndemic ≥ 2 ¹ASSIST (WHO), ² Binge drinking (NIAAA,2004), ³ PHQ-9(KROENKE et. al, 2001,  SCB(PARSONS, 2016)

  5. METHODS • Study variables • Sociodemographics (age, race/color, education, employment status, marital status) • Sexual risk : condomless anal sex, sexually transmitted infections (STI), sex with a HIV positive partner, transactional sex, post-exposureprophylaxis (PEP), HIV testing, perceived likelihood of getting HIV • Mental health: anxiety (GAD-7)*, high impulsivity (Barrat Impulsiveness Scale-11)*², substance abuse/dependence, suicide risk • Vulnerabilities: physical/ sexual violence, child abuse, school dropout • Gender discrimination • Statistical Analysis • Bivariate analysis: Chi-square, Fisher’s exact test and Mann–Whitney U test • Multiple logistic regression including variables with p<0.2 at bivariate *SPITZER RL, et al, 2006;*²PATTON JH, 1995

  6. RESULTS • 147TGW screened and 143 had valid results for outcome variables. Prevalence of syndemicconditionsamong 143 TGW screened for PrEPARADASstudy. Rio de Janeiro, Brazil, 2018 

  7. NUMBER OF SYNDEMIC CONDITIONS AMONG TGW SCREENED FOR PrEPARADAS STUDY, RIO DE JANEIRO, 2017-2018 Syndemicsprevalence 49.7% (n=71) N=143

  8. DEMOGRAPHIC CHARACTERISTICS OF TGW SCREENED FOR PrEPARADAS STUDY ACCORDING TO SYNDEMICS, RIO DE JANEIRO, BRAZIL, 2017-2018 ꝉ Categorieswithmissing data.*chi-square, Fisher's or Mann–Whitney U test.1U$ = R$3.75

  9. SEXUAL RISK BEHAVIOR AND RISK PERCEPTION AMONG TGW SCREENED FORPrEPARADAS’ STUDY ACCORDING TO SYNDEMICS, RIO DE JANEIRO, BRAZIL, 2017-2018 *Chi-squareorFisher's exact test;¹ missing data(n=1)

  10. SUBSTANCE USE AMONG TGW SCREENED FOR PrEPARADAS STUDY ACCORDING TO SYNDEMICS, RIO DE JANEIRO, BRAZIL, 2017-2018 *Chi-square ;2Fisher's exact test.aASSIST score≥4; bASSIST score ≥10; There were no cases of hypnotic abuse and opioid use or abuse

  11. SUBSTANCE ABUSE/DEPENDENCE AMONG TGWSCREENED FOR PrEPARADAS STUDY ACCORDING TO SYNDEMICS, RIO DE JANEIRO, BRAZIL, 2017-2018 *Chi-square ;2Fisher's exact test.aASSIST score≥4; bASSIST score ≥10; There were no cases of hypnotic abuse and opioid use or abuse

  12. MENTAL HEALTH, VULNERABILITIES AND DISCRIMINATION AMONG TGW SCREENED FOR PrEPARADAS STUDY ACCORDING TO SYNDEMICS, RIO DE JANEIRO, BRAZIL, 2017-2018 *Chi-square test

  13. MULTIPLE LOGISTIC REGRESSION MODEL EVALUATING FACTORS ASSOCIATED WITH SYNDEMICS AMONG TGW SCREENED FOR PrEPARADAS STUDY, RIO DE JANEIRO, BRAZIL, 2017-2018 Note: Mostparcimouniousmodelwasselectedincludingonlyvariables p<0.05 orthosefoundtobecounfunders. Missing income cases (n=15) wereimputedwithmedian income. Anxiety (GAD7 >10); High impulsiveness = BIS11 >77)

  14. CONCLUSIONS • High prevalence of syndemics (49.7%) among Brazilian TGW • More likely to occur among non-white, those reporting history of sexual/physical violence and high impulsivity • History of sexual/physical violence + anxiety symptoms Post–Traumatic Stress Disorder? • No association between syndemics and sexual risk behavior • Due to high prevalence in both groups as sexual risk behavior was an inclusion criteria • High demand of mental health treatment vs. low availability in LMIC • PrEP is an opportunity to screen and treat mental health and substance use disorders in this vulnerable and stigmatized population

  15. ACKNOWLEDMENTS • Studyparticipants • PrEPARADASDemonstration Project team • Community educators: Laylla Monteiro, Cléo Souza, Biancka Fernandes, Toni dos Santos, and Josias Freitas • LAPCLIN-AIDS, INI, FIOCRUZ, Rio de Janeiro, Brazil • Brazilian National Department of Surveillance, Prevention and Control of sexually transmitted diseases (STIs), HIV/AIDS and Viral Hepatitis, Brazilian Ministry of Health • CNPq • FAPERJ • Gilead • Dep. Jean Wyllys

More Related