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BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Human Immunodeficiency Virus | Research

Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil

Authors: 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

Published in: BMC Public Health | Issue 1/2024

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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.
Appendix
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Metadata
Title
Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil
Authors
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
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18224-3

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