A study recently published in The Journal of Acquired Immune Deficiency Syndromes indicates that transgender (trans) women in Brazil had low levels of pre-exposure prophylaxis (PrEP) awareness. This was combined with significant proportions being willing to use PrEP as a prevention tool and being eligible for PrEP.
Another recent qualitative study published in Culture, Health and Sexuality provides a contextual frame for these findings as it explores the HIV programming needs of trans women in Brazil. Several social and contextual factors, such as experienced and anticipated trans discrimination and HIV stigma, were linked to an avoidance of prevention and treatment services for both HIV-negative and positive trans women. In addition to biomedical interventions, socio-structural interventions also emerged as crucial for trans women in Brazil.
Globally, trans women are at a disproportionally higher risk of contracting HIV – this is estimated at 49 times higher than other groups. In the South American context, particularly Brazil, trans women have substantially higher rates of HIV prevalence, even when compared to other key populations such as men who have sex with men. It has been estimated that nearly a third of all trans women in Brazil may be infected with HIV, often accessing healthcare testing and treatment services late. This key population has been described as the most at-risk group in the country.
There is a lack of specific HIV prevention aimed at trans women in Brazil. The unique needs of this community raises specific challenges: transphobia and healthcare-related stigma, social and economic marginalisation, as well as issues related to gender-related health care (such as concerns about interactions between HIV medications and hormone therapy).