RESUMO

Characterization of HIV risk factors among transwomen and men who have sex with men (MSM) should be assessed separately and independently. However, due to several constraints, these populations continue to be conflated in clinical research and data. There are limited datasets globally powered to make such comparisons. The study aimed to use one of the largest surveys of transwomen and MSM in Latin America to determine differences in HIV risk and related correlates between the two populations. Secondary data analysis was completed using a cross-sectional biobehavioral survey of 4413 MSM and 714 transwomen living in Perú. Chi Square analysis of selected HIV correlates was conducted to examine differences between transwomen and MSM. Additionally, stratified binary logistic regression was used to split data for further comparative analyses of correlates associated with transwomen and MSM separately. HIV prevalence among transwomen was two-fold greater than among MSM (14.9% vs. 7.0%, p<0.001). Transwomen had a higher prevalence of most HIV risk factors assessed, including presence of alcohol dependence (16.4% vs. 19.0%; p < .001) and drug use in the past 3 months (17.0% vs. 14.9%). MSM were more likely to use marijuana (68.0% vs. 50.0%, p < .001), and transwomen were more likely to engage in inhaled cocaine use (70.0% vs. 51.1%, p < .001). The regression exposed differences in correlates driving sub-epidemics in transwomen vs. MSM, with a trend of substance use increasing HIV risk for transwomen only. Transwomen were more likely to be HIV-infected and had different risk factors from MSM. Targeted prevention strategies are needed for transwomen that are at highest risk. Additionally, further research is needed to determine if these observations in Perú regarding substance use patterns and the role of substance use in HIV risk relate to other trans populations globally.

RESUMO

BACKGROUND: Globally, there is evidence supporting the co-occurrence of intimate partner violence (IPV), substance use disorders (SUD) and mental health disorders among women in prisons, however, there is limited research investigating these domains in the Andean region where rates of female incarceration have increased. The study objective was to explore the prevalence of IPV, SUD and depression among incarcerated women in a Peruvian prison and explore associations among these variables and related correlates. METHODS: 249 incarcerated women responded to a questionnaire about IPV, substance use, depression, and sexual behavior, and were screened for HIV/sexually transmitted diseases (STDs). Univariate analysis and logistic regression were used to estimate relative risk and the influence of substance use and depression on IPV rates. RESULTS: Twelve months prior to incarceration, of the women with sexual partners pre-incarceration (n = 212), 69.3% experienced threats of violence, 61.4% experienced ≥1 acts of physical violence, and 28.3% reported ≥1 act of sexual aggression. Pre-incarceration, 68.1% of drug-using women had a SUD, and 61.7% of those who consumed alcohol reported hazardous/harmful drinking. There were 20 (8.0%) HIV/STD cases; and 67.5% of the women reported depressive symptoms. Compared to women with no experiences of physical violence, a greater proportion of women who experienced least l violent act had depressive symptoms and engaged in sex work pre-incarceration. Depression was associated with physical violence (adjusted relative risk = 1.35, 95% confidence interval: 1.14-1.58). RECOMMENDATIONS: The findings provide evidence of a syndemic of IPV, substance abuse and depression among incarcerated women in a Peruvian prison. To help guide policy makers, further research is needed to determine if this is indicative of trends for other at-risk women in the region, and viable options to treat these women during incarceration to prevent recidivism and other long-term negative sequalae.

Assuntos

RESUMO

BACKGROUND: Although risk factors of recurrent and persistent bacterial vaginosis (BV) have been explored in the literature, the longitudinal incidence patterns of BV remain elusive. METHODS: We conducted a secondary analysis of longitudinal data from a randomized clinical trial of metronidazole treatment for asymptomatic BV. Repeated-measures latent class analysis was used to identify distinct longitudinal patterns of incident BV cases. Multinomial regression analysis was used to determine the predictors of class membership. The multivariable model included age, last BV treatment, douching frequency, birth control, sexual risk behavior, and assignment to treatment arm. RESULTS: A total of 858 African American women who were asymptomatic for BV were included in the analysis. Three emergent patterns of BV for 12 months were identified by repeated-measures latent class analysis: persistent (55.9%), recurrent (30.5%), and clearance (13.5%). Participants who had douched at least once had significantly lower odds to be in the recurrent class versus the clearance class (adjusted odds ratio [adjOR], 0.55; 95% confidence interval [CI], 0.18-0.63). Women who had sex with women had significantly lower odds of belonging to the persistent class versus the clearance class (adjOR, 0.38; 95% CI, 0.22-0.68) and the recurrent class (adjOR, 0.43; 95% CI, 0.23-0.81). Those who were assigned to the treatment arm had significantly increased odds of being in the recurrent class versus the clearance class (adjOR, 1.92; 95% CI, 1.22-3.03). Women older than 21 years were significantly more likely to be in the recurrent class (adjOR, 1.88; 95% CI, 1.17-3.00) than in the clearance class. CONCLUSIONS: Assessment of BV cases revealed distinct patterns of recurrence and persistence of BV, which were significantly associated with douching, being in the treatment arm, and being a woman who had sex with women.

Assuntos