Skip to main content

Advertisement

SpringerLink
Log in

HIV-Related Healthcare Needs and Access Barriers for Brazilian Transgender and Gender Diverse People

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The aim of this study is to investigate HIV-related healthcare needs and access barriers for Brazilian transgender and gender diverse people. Data were collected from gender identity clinics and the questionnaire was also made available on the Internet. Out of the 543 participants—62.1% (n = 337) transgender women, 28.7 (n = 156) transgender men and 9.2% (n = 50) gender diverse people, 63.7% had been tested at least once in their lives. The prevalence of self-reported HIV-positive status among transgender women was 16.5%, of which 92.0% reported having a physician with whom they regularly consulted about HIV, whereas none of the transgender men or gender diverse people reported HIV-positive status. In addition, 8.2% of transgender men and 12.5% of gender diverse people did not know their serological status. Finally, 71.0% of the participants were unfamiliar with post-exposure prophylaxis. The study discusses the need for adequate behavior-oriented HIV health policies and training of healthcare professionals regarding the needs of Brazilian transgender and gender diverse people.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infec Dis. 2013;13(3):214–22. https://doi.org/10.1016/S1473-3099(12)70315-8.

    Article  Google Scholar 

  2. Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86. https://doi.org/10.1016/S0140-6736(14)60833-3.

    Article  PubMed  Google Scholar 

  3. Costa AB, Fontanari AMV, Jacinto MM, et al. Population-based HIV prevalence and associated factors in male-to-female transsexuals from southern Brazil. Arch Sex Behav. 2015;44(2):521–4. https://doi.org/10.1007/s10508-014-0386-z.

    Article  PubMed  Google Scholar 

  4. Grinsztejn B, Jalil EM, Monteiro L, et al. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV. 2017;4(4):169–76. https://doi.org/10.1016/s2352-3018(17)30015-2.

    Article  Google Scholar 

  5. Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC Public Health. 2012;12(1):1–12. https://doi.org/10.1186/1471-2458-12-292.

    Article  Google Scholar 

  6. Herbst JH, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17. https://doi.org/10.1007/s10461-007-9299-3.

    Article  PubMed  Google Scholar 

  7. Reisner SL, Murchison GR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health. 2016;11(7–8):866–87. https://doi.org/10.1080/17441692.2015.1134613.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Scheim IA, Jackson R, James L, Sharp Dopler T, Pyne J, Bauer GR. Barriers to well-being for aboriginal gender-diverse people: results from the Trans PULSE Project in Ontario, Canada. Ethn Inequal Health Soc Care. 2013;6(4):108–20. https://doi.org/10.1108/EIHSC-08-2013-0010.

    Article  Google Scholar 

  9. Costa AB, Peroni RO, Camargo ES, Pasley A, Nardi HC. Prejudice toward gender and sexual diversity in a Brazilian Public University: prevalence, awareness, and the effects of education. Sex Res Social Policy. 2015;12(4):261–72. https://doi.org/10.1007/s13178-015-0191-z.

    Article  Google Scholar 

  10. Cerqueira-Santos E, Calvetti PU, Rocha K, Moura A, Barbosa L, Herme J. Percepção de Usuários Gays, Lésbicas, Bissexuais e Transgêneros, Transexuais e Travestis do Sistema Único de Saúde [Perception of gay, lesbian, bisexual and transgender, transsexual and travesti users about Brazilian unified health system]. Interam J Psychol. 2010;44(2):235–45. https://doi.org/10.1007/s10508-014-0386-z.

    Article  Google Scholar 

  11. Balzer C, Hutta JS, Adrián T, Hyndal P. Transrespect versus transphobia worldwide: a comparative review of the human-rights situation of gender-variant/trans people. Berlin: Transgender Europe (TGEU); 2012.

    Google Scholar 

  12. Costa AB, Rosa FHT, Pase PF, Fontanari AMV, Catelan RF, Mueller A, et al. Healthcare needs of and access barriers for Brazilian transgender and gender diverse people. J Immigr Minor Health. 2016. https://doi.org/10.1007/s10903-016-0527-7.

    Article  Google Scholar 

  13. Andrinopoulos K, Hembling J, Guardado ME, Maria Hernandez F, Nieto AI, Melendez G. Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador. AIDS Behav. 2015;19(1):60–71. https://doi.org/10.1007/s10461-014-0813-0.

    Article  PubMed  Google Scholar 

  14. Bao A, Colby DJ, Trang T, et al. Correlates of HIV testing among transgender women in Ho Chi Minh, Vietnam. AIDS Behav. 2016;20(Suppl 3):371–8. https://doi.org/10.1007/s10461-016-1574-8.

    Article  PubMed  Google Scholar 

  15. Pal K, Ngin C, Tuot S, et al. Acceptability study on HIV self-testing among transgender women, men who have sex with men, and female entertainment workers in Cambodia: a qualitative analysis. PLoS ONE. 2016;11(11):e0166129. https://doi.org/10.1371/journal.pone.0166129.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Lippman SA, Moran L, Sevelius J, et al. Acceptability and feasibility of HIV self-testing among transgender women in San Francisco: a mixed methods pilot study. AIDS Behav. 2016;20(4):928–38. https://doi.org/10.1007/s10461-015-1236-2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Frye V, Wilton L, Hirshfied S, et al. “Just because it’s out there, people aren’t going to use it”: HIV self-testing among young, black MSM, and transgender women. AIDS Patient Care STDS. 2015;29(11):617–24. https://doi.org/10.1089/apc.2015.0100.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Logie CH, Lacombe-Duncan A, Brien N, et al. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc. 2017;20(1):1–9. https://doi.org/10.7448/IAS.20.1.21385.

    Article  Google Scholar 

  19. Woodford MR, Chakrapani V, Newman PA, Shunmugam M. Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai, India. Glob Public Health. 2015. https://doi.org/10.1080/17441692.2015.1057757.

    Article  PubMed  Google Scholar 

  20. Wirtz AL, Clouse E, Veronese V, et al. New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self-testing among men who have sex with men and transgender women in Yangon, Myanmar. PLoS ONE. 2017;20(1):1–9. https://doi.org/10.7448/IAS.20.1.21796.

    Article  Google Scholar 

  21. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24. https://doi.org/10.1016/S0277-9536(02)00304-0.

    Article  PubMed  Google Scholar 

  22. Boerma JT, Weir SS. Integrating demographic and epidemiological approaches to research on HIV/AIDS: the proximate-determinants framework. J Infect Dis. 2005;191(Supp 1):S61–7. https://doi.org/10.1086/425282.

    Article  PubMed  Google Scholar 

  23. Lewis ND. Is the social–ecological framework useful in understanding infectious diseases? The case of HIV/AIDS. EcoHealth. 2005;2(4):343–8.

    Article  Google Scholar 

  24. TransPULSE. Provincial survey. 2012. http://transpulseproject.ca/wp-content/uploads/2012/05/Trans-PULSE-survey-information-only-copy-2012.pdf.

  25. Reisner SL, Conron KJ, Tardiff LA, Jarvi S, Gordon AR, Austin SB. Monitoring the health of transgender and other gender minority populations: validity of natal sex and gender identity survey items in a U.S. national cohort of young adults. BMC Public Health. 2014;14(1):1224. https://doi.org/10.1186/1471-2458-14-1224.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Carvalho M, Carrara S. Em direito a um futuro trans?: contribuição para a história do movimento de travestis e transexuais no Brasil [Towards a trans future? Contributions to a history of the travesti and transsexual movement in Brazil]. Sex Salud Soc. 2013;14:319–51. https://doi.org/10.1590/s1984-64872013000200015.

    Article  Google Scholar 

  27. Barbosa C. “Doidas e putas”: usos das categorias travesti e transexual [“Freaks and whores”: uses of travesti and transsexual categories]. Sex Salud Soc. 2013;14(2):352–79. https://doi.org/10.1590/s1984-64872013000200016.

    Article  Google Scholar 

  28. Socías ME, Marshall BD, Arístegui I, et al. Factors associated with healthcare avoidance among transgender women in Argentina. Int J Equity Health. 2014;13(1):1–12. https://doi.org/10.1186/s12939-014-0081-7.

    Article  Google Scholar 

  29. Pinheiro Junior FM, Kendall C, Martins TA, et al. Risk factors associated with resistance to HIV testing among transwomen in Brazil. AIDS Care. 2016;28(1):92–7. https://doi.org/10.1080/09540121.2015.1066751.

    Article  PubMed  CAS  Google Scholar 

  30. Pascom ARP, Arruda MR, Simão MBG. Pesquisa de conhecimentos, atitudes e práticas na população brasileira de 15 a 64 anos 2008 [Research on knowledge, attitudes and practices in the Brazilian population from 15 to 64 years-old 2008]. Ministério da Saúde, Brasília, Brazil; 2011.

  31. Sousa PJD, Ferreira LOC, Sá JBD. Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil [Descriptive study of homophobia and vulnerability to HIV/Aids of the transvestites in the Metropolitan Region of Recife, Brazil]. Cien Saude Colet. 2013;18(8):2239–51. https://doi.org/10.1590/S1413-81232013000800008.

    Article  PubMed  Google Scholar 

  32. Martins TA, Kerr LRF, Macena RH, et al. Travestis, an unexplored population at risk of HIV in a large metropolis of northeast Brazil: a respondent-driven sampling survey. AIDS Care. 2013;25(5):606–12. https://doi.org/10.1080/09540121.2012.726342.

    Article  PubMed  Google Scholar 

  33. Brazilian Ministry of Health. Boletim epidemiológico AIDS e DST [Epidemiological data on AIDS and IST]. Ministério da Saúde, Brasília, Brazil; 2012.

  34. World Health Organization. Post-exposure prophylaxis to prevent HIV infection. Geneva: WHO; 2014. http://www.who.int/hiv/topics/prophylaxis/info/en/.

  35. Silva AS, Barboza R. Exclusão social e consciência política: luta e militância de transgêneros no ENTLAIDS [Social exclusion and political awareness: transgender struggle and activism in ENTLAIDS]. Cadernos CERU. 2009;20:257–76.

    Google Scholar 

  36. Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19(2):69–79. https://doi.org/10.1093/heapol/czh009.

    Article  PubMed  Google Scholar 

  37. Weinhardt LS, Forsyth AD, Carey MP, Jaworski BC, Durant LE. Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice. Arch Sex Behav. 1998;27(2):155–80.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Mota RMS, Kerr LRFS, Kendall C, Pinho A, de Mello MB, Dourado I, et al. Reliability of self-report of HIV status among men who have sex with men in Brazil. JAIDS. 2011;57:S153–6.

    Google Scholar 

Download references

Funding

This study was funded by the Universal Issuance 477016/2013-8 Universal Public Call 14/2013—Track C by of the Brazilian National Council of Technological and Scientific Development (CNPQ), and through PROEX and PDSE grants from the Coordination for the Improvement of Higher Education Personnel (CAPES).

Author information

Authors and Affiliations

  1. Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga 6681, Prédio 11, Sala 933, Porto Alegre, RS, Brazil

    Angelo Brandelli Costa, Juliana Ledur Stucky & Paola Fagundes Pase

  2. Gender Identity Program (PROTIG), Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Anna Martha Vaitses Fontanari, Karine Schwarz, Heitor Tome da Rosa Filho & Maria Inês Rodrigues Lobato

  3. Department of Social Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Ramiro Figueiredo Catelan & Henrique Caetano Nardi

  4. Transdisciplinary Gender Identity and Sexual Orientation Service (AMTIGOSNUFOR), Hospital de Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Universidade de São Paulo (USP), São Paulo, SP, Brazil

    Daniel Augusto Mori Gagliotti & Alexandre Saadeh

  5. Department of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Silvia Helena Koller

  6. Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa

    Silvia Helena Koller

Authors
  1. Angelo Brandelli Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Martha Vaitses Fontanari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ramiro Figueiredo Catelan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karine Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juliana Ledur Stucky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heitor Tome da Rosa Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paola Fagundes Pase
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Augusto Mori Gagliotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexandre Saadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maria Inês Rodrigues Lobato
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Henrique Caetano Nardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Silvia Helena Koller
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed significantly and are in agreement regarding the contents of this manuscript. AC designed the study, wrote the protocol, was responsible for analysis, and participated in data interpretation, draft of the article and final approval of this version. AF, JS and RC participated in data analysis and interpretation, draft of the article and final approval of this version. HF, DG, KS and PP participated in the study design and final approval of the article. AS, HN, ML and SK were responsible for the study design and data interpretation, as well as draft of the article and its final approval.

Corresponding author

Correspondence to Angelo Brandelli Costa.

Ethics declarations

Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costa, A.B., Fontanari, A.M.V., Catelan, R.F. et al. HIV-Related Healthcare Needs and Access Barriers for Brazilian Transgender and Gender Diverse People. AIDS Behav 22, 2534–2542 (2018). https://doi.org/10.1007/s10461-017-2021-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-2021-1

Keywords

Search

Navigation