Background The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen, and identify the factors associated with newly diagnosed HIV infections. Methods “Transcender” was a respondent driven sampling study of transwomen in Rio de Janeiro, Brazil, conducted from August 2015 to January 2016. Twelve seeds were recruited from social movements and formative phase. Eligibility criteria were: self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or metropolitan area, and having a valid peer recruitment coupon. Participants were categorized as HIV-negative, known HIV infected, or newly diagnosed as HIV infected. Predictors of newly diagnosed HIV infections were assessed by comparing the newly diagnosed with the HIV-negative. Population estimates were adjusted using the RDSII estimator. Findings In total, 345 eligible transwomen were enrolled. The study sample was young and diverse on gender identity. Population estimates of no prior HIV testing, HIV-infection and newly diagnosed as HIV-infected were 29·1%, 32·1% and 7·0%, respectively (based on n=60 with no prior testing, n=141 HIV-infected, n=40 newly diagnosed). Syphilis, rectal chlamydia and gonorrhea infection were diagnosed in 28·9%, 14·6%, and 13·5%, respectively. Newly diagnosed HIV infections were associated with black race (22·8; 95%CI 2·9–178·9), travesti (34·1; 95%CI 5·8–200·2) or transsexual woman (41·3; 95%CI 6·3–271·2) gender identity, history of sex work (30·7; 95%CI 3·5–267·3), and history of sniffing cocaine (4·4; 95%CI 1·4–14·1). Interpretation Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health care and prevention services in order to curb the HIV epidemic and improve the quality-of-life of transwomen in Brazil. Funding This work was supported by Brazilian Research Council (470056/2014-2) and NIAID-NIH (UM1AI069496).

Introduction: Travestis and transgender women resort to the use of hormones for body modification. Due to restrictions in the access to health services, self-medication is frequent. The aim of this study was to describe the self-reported prevalence of hormones used by travestis and transgender women in the Federal District. Method: This is a cross-sectional study with Respondent Driven Sampling (RDS) and Knowledge, Attitudes and Practices questionnaire (KAP) along with travestis and transgender women over 18 years in the FD. Prevalence was calculated using the RDS-II estimator. Logistic models were used to investigate the associated factors. A total of 201 volunteers participated. Results: There was a young sample (median age of 24 years). The overall prevalence of continuous use of hormones was 64.5%. The most used formulation was the combination of estrogen and progesterone (86.2%) by injectable (75.1%) and oral (66%) administration. Most participants (84%) got the hormones without a prescription. Guidance on the use of these hormones came from their peers in 41% of the cases. We observed that the continuous use of hormones is associated with race, income and age, as well as the search for guidance of healthcare professionals, which is also associated with schooling. Discussion: The reality of the process of hormone use by these people in the quest for femininity is reflected in high rates of self-medication. Conclusion: This study contributes to the visibility of the need to improve the access conditions of these people to health services.

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A dinâmica da epidemia de HIV/aids vem passando por modificações ao longo do tempo sendo um dos principais problemas de saúde pública no Brasil e no mundo. O objetivo foi verificar a tendência temporal e o perfil epidemiológico de pessoas vivendo com HIV/aids. O estudo de Coorte retrospectivo com dados de 1078 pessoas vivendo com HIV e AIDS (PVHA) em Terapia Antiretroviral (TARV) entre 2002 e 2017 no município de Ponta Grossa-PR, Brasil. Utilizou-se frequências absoluta, as categorias de exposição e as diferenças foram verificadas entre grupos com teste Kruskall-Wallys. A tendência temporal foi verificada com regressão de Poisson (p<0,05). O perfil das PVHA foi descrito pela análise de correspondência múltipla. Foram avaliados 1078 PVHA, sendo 55,9% eram homens brancos, com idade média de 35,9 anos, casados, heterossexuais, transmissão foi sexual e com baixa escolaridade. A taxa média de incidência foi de 20,8/100.000 habitantes, com incremento de 5% ao ano, sendo maior entre os homens (8%). Diante da dinamicidade da infecção, deve-se repensar formas de abordagem nas estratégias de detecção de casos e prevenção.

This article focuses on the need for expanded stakeholder involvement as a means of enhancing the Botswana Department of Secondary Education (DSE) HIV and AIDS strategic plan. Research has indicated that the effects of HIV and AIDS on the supply of and demand for education are considerable. Using a questionnaire and interviews, the research has established that the current DSE HIV and AIDS strategic plan lacks comprehensive strategies for preventing HIV spread in schools. Furthermore, the study has shown that there is limited external stakeholder involvement. The study, therefore, has explored how greater success could be realized. The study has concluded that the strategic plan can be improved through expanded external stakeholder involvement at all the stages of the strategic plan. In order to enhance the DSE strategic plan, a stakeholder involvement model is presented.

IntroductionPeer dialogues influence the adoption of behavioural changes to reduce the risk of HIV infection (human immunodeficiency virus). By intervening experimentally in the community to change risk behaviour patterns, it may be possible to promote widespread reductions in HIV risk practices within a population.MethodsThe intervention identified and trained young age range 18–26 people who are reliably identified as leaders among one of these key populations - gay men and MSM, transgender people (transvestites and transsexual women), drug users and harm reducers and sex workers - in all five regions of Brazil to act as multipliers of behavioural changes for their peers, in relation to HIV. We also include young people living with HIV, considering that it is important that these young people share the experience of living with HIV with other young people in greater vulnerability and risk. Results140 young people from the key populations were trained in the 5 Brazilian regions. The proportions of the key populations trained in this intervention were 41.9 per cent homosexuals and MSM, 14.5 per cent harm reduction or drug users, 8 per cent transgender people, 6 per cent sex workers and 15 per cent young people living With HIV. Approximately 70% of young trained in this intervention have already developed some activity to multiply the information about prevention and behavioural practices to reduce HIV infection in their respective territories and communities, promoting knowledge about combination prevention and changes related to sexual practices and behaviours.ConclusionInterventions that empower young to endorse change can produce or accelerate changes in the behaviour and sexual practices of the young population to reduce the risk of HIV infection. These interventions have developed a network of multipliers in a successive chain of HIV information and combination prevention to reduce HIV infection and risk behaviours through peer-to-peer communication at the community level among young key populations in Brazil.