Transcendendo: A Cohort Study of HIV-Infected and Uninfected Transgender Women in Rio de Janeiro, Brazil

Abstract

Purpose: Worldwide, the burden of adverse health conditions is substantial among travestis and transgender women (trans women). Transcendendo, the first trans-specific cohort in a low- or middle-income country, is an open cohort established in August 2015 to longitudinally evaluate the health aspects of trans women aged ≥18 years in Rio de Janeiro, Brazil.Methods: Study visits occur on an annual basis. Data on sociodemographics, behavioral, gender transition, affirmation procedures, hormone use, discrimination, violence, clinical and mental health, HIV prevention, and care (for those HIV-infected) are collected. Physical examination, anthropometric measurements, and laboratory tests are performed.Results: As of July 2017, 322 trans women were enrolled in the cohort with a median age of 31.5 years (interquartile range 25.7–39.5), of whom 174 (54%) were HIV-infected. The Transcendendo baseline information reinforces the scenario of marginalization and deprivation surrounding trans women. Most participants had low income (62.0% were living with below US$ 10.00/day), showed a very high engagement in sex work (78.6%), and reported increased occurrence of sexual (46.3%) and physical (54.0%) violence. Pre-exposure peophylaxis (PReP) was used by 18.8% of the HIV-uninfected trans women, only through research participation. Positive screening for depression (57.8%) and problematic use of tobacco (56.6%), cannabis (28.9%), cocaine (23.8%), and alcohol (21.5%) were high. Almost all participants (94.8%) reported hormone use at some point, mostly without medical supervision (78.7%).Conclusion: Our results describe a context of exclusion experienced by trans women, exposing vulnerabilities of this population in a middle-income country, with poor access to trans-specific care, HIV prevention and care, and mental health care. Addressing transgender experiences and needs can help the development of strategies to diminish stigma, improve health care environment, guide future research on trans morbidities, substance use, and trans-specific interventions to support health-related recommendations. Ultimately, it contributes to close the gaps concerning transgender health and reinforces that trans care cannot be disentangled from the social environment that surrounds trans women.

Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment

“…As educational level was our primary exposure of interest, only adults aged 25 years or older were included to allow for completion of college education. For the present analysis, transgender women participants had to be excluded given that, through both the respondent driven sampling study [ 24 ] and the Transcendendo cohort [ 25 ], they were actively recruited for HIV testing and care at our institution, thus modifying the means of achieving our health care facility and, therefore the probability of late treatment initiation (Fig. 1 ).…”

Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior

“…Our findings on mental health problems, suicidal thoughts and tobacco/illicit drug use, although restricted to this online sample, indicate that social distancing measures may be disproportionally affecting TGNB individuals. Transphobia and stigma may lead to the high rates of mental health problems and substance use among transgender women in Brazil [ 9 , 33 ], and the COVID-19 pandemic may be an additional burden for this population. In-depth assessments among transgender populations are necessary to better understand such associations.…”

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, “Passing” Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

“…Between 33.85% and 45.16% of these individuals are not currently employed, most of them reporting having jobs denied due to their gender identity [ 32 ]. A study on the health conditions of TW in the state of Rio de Janeiro found that the participants had low income (62.0% lived on less than USD10.00/day), demonstrated a very high involvement in sex work (78.6%) and reported a higher occurrence of sexual (46.3%) and physical (54.0%) violence [ 33 ]. There is scarce data on transgender men (TM), a neglected population in research settings whose environmental conditions and associated vulnerabilities are not well documented in Brazilian context.…”