Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil
Abstract Background Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV le...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-18224-3 |
| _version_ | 1827315688647163904 |
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| author | Maria Amelia de Sousa Mascena Veras Neia Prata Menezes Adrienne Rain Mocello Anna M. Leddy Gustavo Santa Roza Saggese Katia Cristina Bassichetto Hailey J Gilmore Paula Galdino Cardin de Carvalho Luca Fasciolo Maschião Torsten B. Neilands Jae Sevelius Sheri A. Lippman |
| author_facet | Maria Amelia de Sousa Mascena Veras Neia Prata Menezes Adrienne Rain Mocello Anna M. Leddy Gustavo Santa Roza Saggese Katia Cristina Bassichetto Hailey J Gilmore Paula Galdino Cardin de Carvalho Luca Fasciolo Maschião Torsten B. Neilands Jae Sevelius Sheri A. Lippman |
| author_sort | Maria Amelia de Sousa Mascena Veras |
| collection | DOAJ |
| description | Abstract Background Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. Methods A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. Results A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). Conclusion Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. Trial registration ClinicalTrials.gov Identifier: NCT03525340. |
| first_indexed | 2024-04-24T23:01:48Z |
| format | Article |
| id | doaj.art-a04e72812a994a13b7144775a7211c4f |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-24T23:01:48Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-a04e72812a994a13b7144775a7211c4f2024-03-17T12:40:51ZengBMCBMC Public Health1471-24582024-03-012411810.1186/s12889-024-18224-3Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in BrazilMaria Amelia de Sousa Mascena Veras0Neia Prata Menezes1Adrienne Rain Mocello2Anna M. Leddy3Gustavo Santa Roza Saggese4Katia Cristina Bassichetto5Hailey J Gilmore6Paula Galdino Cardin de Carvalho7Luca Fasciolo Maschião8Torsten B. Neilands9Jae Sevelius10Sheri A. Lippman11Department of Collective Health, Santa Casa School of Medical SciencesDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDepartment of Collective Health, Santa Casa School of Medical SciencesDepartment of Collective Health, Santa Casa School of Medical SciencesDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDepartment of Collective Health, Santa Casa School of Medical SciencesDepartment of Collective Health, Santa Casa School of Medical SciencesDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDivision of Prevention Science, Department of Medicine, University of California, San FranciscoDivision of Prevention Science, Department of Medicine, University of California, San FranciscoAbstract Background Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. Methods A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. Results A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). Conclusion Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. Trial registration ClinicalTrials.gov Identifier: NCT03525340.https://doi.org/10.1186/s12889-024-18224-3Gender-based violenceHIV careTransgender personsBrazilHIVMedication adherence |
| spellingShingle | Maria Amelia de Sousa Mascena Veras Neia Prata Menezes Adrienne Rain Mocello Anna M. Leddy Gustavo Santa Roza Saggese Katia Cristina Bassichetto Hailey J Gilmore Paula Galdino Cardin de Carvalho Luca Fasciolo Maschião Torsten B. Neilands Jae Sevelius Sheri A. Lippman Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil BMC Public Health Gender-based violence HIV care Transgender persons Brazil HIV Medication adherence |
| title | Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil |
| title_full | Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil |
| title_fullStr | Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil |
| title_full_unstemmed | Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil |
| title_short | Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil |
| title_sort | correlation between gender based violence and poor treatment outcomes among transgender women living with hiv in brazil |
| topic | Gender-based violence HIV care Transgender persons Brazil HIV Medication adherence |
| url | https://doi.org/10.1186/s12889-024-18224-3 |
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