RESUMO
BACKGROUND: Globally, social inequalities contribute to elevated sexually transmitted infections (STIs) rates among transgender women. High syphilis prevalence has been documented among transgender women in Latin America. Little is known, however, of syphilis testing uptake among transgender women in Jamaica, where homosexuality is criminalized. The study objective was to understand factors associated with opting-in for syphilis testing and a syphilis infection history among transgender women in Jamaica. METHODS: We conducted a cross-sectional tablet-based survey of 137 transgender women between March and November 2015 in Jamaica. Bivariate analyses were used to assess differences across sociodemographic, intrapersonal, interpersonal, and structural factors based on syphilis infection history. We conducted univariable and multivariable logistic regression to determine the odds ratio for opting-in for syphilis testing for all factors associated with testing uptake at a P value of less than 0.05 in bivariate analyses, controlling for sociodemographic characteristics. RESULTS: Among 137 participants, 83 (60.6%) opted in for syphilis screening and 8 (9.6%) had positive rapid test results. One quarter of participants (n = 26; 25.2%) reported being HIV positive. Opting-in for syphilis testing was associated with the following: 1 health (HIV-positive serostatus: adjusted odds ratio [AOR], 4.33; 95% confidence interval [CI], 1.31-14.26), 1 intrapersonal (perceived STI risk: AOR, 1.58; 95% CI, 1.04-2.40), 1 interpersonal (childhood sexual abuse: AOR, 2.80; 95% CI, 1.03-7.62), and 1 structural (incarceration: AOR, 0.27; 95% CI, 0.11-0.71) factor. CONCLUSIONS: This study identified factors (HIV-positive serostatus, perceived STI risk, childhood sexual abuse, no incarceration history) associated with syphilis testing uptake among transgender women. Findings can inform multilevel STI testing, prevention, and care strategies tailored for transgender women in Jamaica.
Assuntos
Sífilis/diagnóstico , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Abuso Sexual na Infância , Estudos Transversais , Feminino , Soropositividade para HIV , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Masculino , Programas de Rastreamento , Razão de Chances , Sífilis/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. METHODS: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. RESULTS: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement. CONCLUSION: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.
Assuntos
Profissionais do Sexo/psicologia , Pessoas Transgênero/psicologia , Violência , Mulheres/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Jamaica , Delitos Sexuais , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual , Estigma Social , Maus-Tratos Conjugais , Pessoas Transgênero/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Haiti's 2010 earthquake devastated social, health, and economic infrastructure and left 2 million persons homeless. Over 6 years later 61,000 people remain displaced, most lacking protection, services, and durable solutions. Structural contexts elevate risks of gender-based violence (GBV) targeting internally displaced (ID) girls and women. OBJECTIVE: We used an intersectionality framework to explore lived experiences and understanding of violence among ID young men and women in Leogane, Haiti. METHODS: We conducted six focus groups, three with ID young women (n = 30) and three with ID young men (n = 30) aged 18-24 years, and 11 in-depth individual interviews with frontline workers in Leogane. Focus groups and interviews were conducted in Kreyol, transcribed verbatim, translated into English, and analyzed using narrative thematic techniques. RESULTS: Findings revealed violence experienced by ID youth was (re)produced at the intersection of gender, poverty, displacement, and age. Multi-level forms of violence included structural (e.g. poverty), community (e.g. gender norms, and interpersonal (e.g. family expectations) dimensions. Coping strategies spanned intrapersonal (hope), community (social support), and structural (employment/education) dimensions. CONCLUSIONS: Interventions to reduce violence should be tailored to address the social inequities that emerge at the intersection of youth, poverty, displacement, and hegemonic gender norms.