Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men

Scheim, Ayden I.; Santos, Glenn-Milo; Arreola, Sonya; Makofane, Keletso; D., Tri; Hébert, P.; Thomann, Matthew; Ayala, George

doi:10.7448/ias.19.3.20779

Cited by 58 publications

(52 citation statements)

References 27 publications

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“…Transgender and other nonbinary populations who suffer stigma and discrimination may have reduced access to services or receive poor quality of care, even though they are typically at higher risk of HIV. 121 HIV services offered during restricted opening hours or in female-dominated sexual and reproductive health services may mitigate against men's access, resulting in lower use of prevention and treatment services. 122…”

Section: End Epidemics Of Aids Tb Malaria Neglected Tropical Diseamentioning

confidence: 99%

Gender equality and gender norms: framing the opportunities for health

et al. 2019

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The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the significant impact of gender inequalities and restrictive gender norms on health risks and behaviours. In this paper we draw on evidence from the Series on Gender Equality, Norms and Health to dispel three myths on gender and health and describe persistent barriers to progress. We propose an agenda for action to reduce gender inequality and shift gender norms for improved health outcomes, calling on leaders in national governments, global health institutions, civil society organisations, academia, and the corporate sector to 1) focus on health outcomes and engage actors across sectors to achieve them; 2) reform the workplace and workforce to be more gender equitable; 3) fill gaps in data and eliminate gender bias in research; 4) fund civil society actors and social movements; and 5) strengthen accountability mechanisms. Paper 5 Lancet Series on Gender Equality, Norms and Health Key Messages of the Series • Gender norms and inequalities affect health outcomes for girls and women, boys and men, and gender minorities.

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Section: End Epidemics Of Aids Tb Malaria Neglected Tropical Diseamentioning

confidence: 99%

Gender equality and gender norms: framing the opportunities for health

et al. 2019

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“…Some factors associated with HIV risk and PrEP indication among trans MSM may be similar to those for cis MSM . Trans MSM may face healthcare barriers, such as lack of health insurance, suboptimal access to HIV testing or delays in utilization of prevention services . Mental health conditions such as psychological distress and substance use behaviours including alcohol and illicit drug use may influence HIV risk behaviours .…”

Section: Introductionmentioning

confidence: 99%

High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

et al. 2019

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Introduction Trans masculine people who have sex with cisgender (“cis”) men (“trans MSM”) may be at‐risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre‐exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. Methods Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self‐reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). Results The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non‐binary gender identity; 32.6% gay‐identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05). Discussion The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP. Conclusions Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.

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“…In many of the countries across sub-Saharan Africa, sexual intercourse between people of the same sex is criminalized, including in Nigeria [6]. In addition, MSM and TGW face significant social stigma and internalized homophobia that may manifest as barriers to the uptake of routine services including screening for HIV and other sexually transmitted infections (STIs) [7–13]. …”

Section: Introductionmentioning

confidence: 99%

High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria

Keshinro¹,

Crowell

Nowak

et al. 2016

Journal of the International AIDS Society

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IntroductionSexually transmitted infection (STI) and HIV prevalence have been reported to be higher amongst men who have sex with men (MSM) in Nigeria than in the general population. The objective of this study was to characterize the prevalence of HIV, chlamydia and gonorrhoea in this population using laboratory-based universal testing.MethodsTRUST/RV368 represents a cohort of MSM and transgender women (TGW) recruited at trusted community centres in Abuja and Lagos, Nigeria, using respondent-driven sampling (RDS). Participants undergo a structured comprehensive assessment of HIV-related risks and screening for anorectal and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae, and HIV. Crude and RDS-weighted prevalence estimates with 95% confidence intervals (CIs) were calculated. Log-binomial regression was used to explore factors associated with prevalent HIV infection and STIs.ResultsFrom March 2013 to January 2016, 862 MSM and TGW (316 in Lagos and 546 in Abuja) underwent screening for HIV, chlamydia and gonorrhoea at study enrolment. Participants’ median age was 24 years [interquartile range (IQR) 21–27]. One-third (34.2%) were identified as gay/homosexual and 65.2% as bisexual. The overall prevalence of HIV was 54.9%. After adjusting for the RDS recruitment method, HIV prevalence in Abuja was 43.5% (95% CI 37.3–49.6%) and in Lagos was 65.6% (95% CI 54.7–76.5%). The RDS-weighted prevalence of chlamydia was 17.0% (95% CI 11.8–22.3%) in Abuja and 18.3% (95% CI 11.1–25.4%) in Lagos. Chlamydia infection was detected only at the anorectal site in 70.2% of cases. The RDS-weighted prevalence of gonorrhoea was 19.1% (95% CI 14.6–23.5%) in Abuja and 25.8% (95% CI 17.1–34.6%) in Lagos. Overall, 84.2% of gonorrhoea cases presented with anorectal infection only. Over 95% of STI cases were asymptomatic. In a multivariable model, increased risk for chlamydia/gonorrhoea was associated with younger age, gay/homosexual sexual orientation and higher number of partners for receptive anal sex. HIV infection was associated with older age, female gender identity and number of partners for receptive anal sex.ConclusionsThere is a high burden of infection with HIV and asymptomatic chlamydia and gonorrhoea among MSM and TGW in Nigeria. Most cases would have been missed without anorectal screening. Interventions are needed to target this population for appropriate STI screening and management beginning at a young age.

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Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men

Cited by 58 publications

References 27 publications

Gender equality and gender norms: framing the opportunities for health

Gender equality and gender norms: framing the opportunities for health

High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria

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