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INTRODUCTION: Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (FTC/TDF) is highly effective in preventing HIV infection. This study aimed to identify factors associated with PrEP early loss to follow-up (ELFU) among gay, bisexual and other men who have sex with men (MSM), travestis and transgender women (TGW). METHODOLOGY: This was a prospective cohort study evaluating TGW and MSM who initiated PrEP at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz) from 2014 to 2020. ELFU was defined as not returning for a PrEP visit within 180 days after first dispensation. Exposure variables included age, gender, race, education, transactional sex, condomless anal intercourse [CAI] (both in the past six months), binge drinking and substance use (both in past three months) and syphilis diagnosis at baseline. Multilevel logistic regression models with random intercepts and fixed slopes were used to identify factors associated with ELFU accounting for clustering of participants according to their PrEP initiation study/context (PrEP Brasil, PrEParadas, ImPrEP and PrEP SUS). RESULTS: Among 1,463 participants, the median age was 29 years (interquartile range 24-36), 83% self-identified as MSM, 17% as TGW, 24% were black, 37% mixed-black/pardo and 30% had < 12 years of education. Fifteen percent reported transactional sex, 59% reported CAI, 67% binge drinking, 33% substance use, and 15% had a syphilis diagnosis. Overall, 137 participants (9.7%) had ELFU. Younger age (18-24 years) (adjusted odds ratio [aOR] 1.9, 95%CI:1.2-3.2), TGW (aOR 2.8, 95%CI:1.6-4.8) and education < 12 years (aOR 1.9, 95%CI:1.2-2.9) were associated with greater odds of ELFU. CONCLUSION: TGW, young individuals and those with lower education were at higher risk of PrEP ELFU. Our results suggest that the development of specific strategies targeting these populations should be a priority, through policies that aim to reduce the incidence of HIV infection.

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Abstract Introduction Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (FTC/TDF) is highly effective in preventing HIV infection. This study aimed to identify factors associated with PrEP early loss to follow-up (ELFU) among gay, bisexual and other men who have sex with men (MSM), travestis and transgender women (TGW). Methodology This was a prospective cohort study evaluating TGW and MSM who initiated PrEP at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz) from 2014 to 2020. ELFU was defined as not returning for a PrEP visit within 180 days after first dispensation. Exposure variables included age, gender, race, education, transactional sex, condomless anal intercourse [CAI] (both in the past six months), binge drinking and substance use (both in past three months) and syphilis diagnosis at baseline. Multilevel logistic regression models with random intercepts and fixed slopes were used to identify factors associated with ELFU accounting for clustering of participants according to their PrEP initiation study/context (PrEP Brasil, PrEParadas, ImPrEP and PrEP SUS). Results Among 1,463 participants, the median age was 29 years (interquartile range 24-36), 83% self-identified as MSM, 17% as TGW, 24% were black, 37% mixed-black/pardo and 30% had < 12 years of education. Fifteen percent reported transactional sex, 59% reported CAI, 67% binge drinking, 33% substance use, and 15% had a syphilis diagnosis. Overall, 137 participants (9.7%) had ELFU. Younger age (18-24 years) (adjusted odds ratio [aOR] 1.9, 95%CI:1.2-3.2), TGW (aOR 2.8, 95%CI:1.6-4.8) and education < 12 years (aOR 1.9, 95%CI:1.2-2.9) were associated with greater odds of ELFU. Conclusion TGW, young individuals and those with lower education were at higher risk of PrEP ELFU. Our results suggest that the development of specific strategies targeting these populations should be a priority, through policies that aim to reduce the incidence of HIV infection.

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RESUMO: Introdução: As pessoas transexuais encontram uma série de dificuldades no atendimento médico, tanto na rede privada como na pública no Brasil. Objetivo: Demonstrar aos profissionais da área da saúde a realidade vivida pelas pessoas transexuais, quando necessitam de atendimento médico no Brasil, visando aprimorar os conhecimentos sobre o atendimento a este grupo populacional. Métodos: Coleta de dados realizada em fevereiro de 2020 com buscas nas bases eletrônicas: PubMed, Scielo, Lilacs e Google Scholar. Utilizou-se os descritores em associação: transgender; medical care; transexual; cross-sex hormone therapy, no período entre 2000 a 2020. Resultados: Encontramos 720 publicações com as palavras-chave transgender persons e medical care, 30 com as palavras-chave transgender, medical care e cross-sex hormone therapy, sendo escassos os estudos feitos no Brasil. Conclusão: Para que ocorra uma melhora no atendimento à saúde das pessoas transexuais é necessário que sejam inseridas disciplinas específicas sobre este tema na grade curricular dos cursos técnicos, de graduação e de pós-graduação da área da saúde. (AU)

ABSTRACT: Introduction: Transsexual people encounter a series of difficulties in medical care, both in the private and public health systems in Brazil. Objectives: Demonstrate to health professionals the reality experienced by transsexual people when they need medical care in Brazil, in order to improve knowledge about the care of this population group. Methods: Data collection was carried out in February 2020 with searches in electronic databases: Pubmed, Scielo, Lilacs and Google Scholar. The following descriptors were used: transgender; medical care; transsexual; cross-sex hormone therapy from 2000 to 2020.Results: We found 720 publications with the keywords transgender persons and medical care, 30 with the keywords transgender, medical care and cross-sex hormone therapy, with few studies conducted in Brazil Conclusion: To improve the health care of transgender people, it is necessary to insert specific disciplines on this topic in the curriculum of technical, undergraduate and graduate courses in the health area. (AU)

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O objetivo deste ensaio teórico consistiu em evidenciar um conjunto de argumentações que possibilite a compreensão da participação de pessoas transgênero no Esporte. Como fonte de inspiração, debruçamo-nos sobre a "carta", amplamente divulgada nas redes sociais, pela ex-atleta Ana Paula Henkel. A carta revela a posição contrária da ex-atleta à participação da atleta trans Tifanny Abreu na Superliga nacional de voleibol, despontando-se um uso argumentativo de forma erística que desconsidera conceitos discutidos e divulgados no meio esportivo e acadêmico. Nesse sentido, podemos desconfiar que essa temática tem suscitado debates limitados ao discurso biomédico e desconsiderado o contexto sociocultural da inserção desses/as atletas. Por fim, importa ressaltar a necessidade de novas investigações sobre o tema para acompanhamento criterioso dos limites e possibilidades da participação trans no Esporte.

The aim of this theoretical essay was to highlight a set of arguments that make it possible to understand the participation of transgender persons in Sport. As a source of inspiration, we look at the "letter", widely disseminated on social networks, by former athlete Ana Paula Henkel. The letter reveals the ex-athlete's opposite position to the participation of trans athlete Tifanny Abreu in the national volleyball Superliga, with an argumentative use in an eristic way that ignores concepts discussed and disseminated in the sports and academic environment. In this sense, we can suspect that this theme has raised debates limited to the biomedical discourse and disregarded the sociocultural context of the insertion of these athletes. Finally, it is important to emphasize the need for further investigations on the subject to carefully monitor the limits and possibilities of trans participation in Sport.

El objetivo de este ensayo teórico fue destacar un conjunto de argumentos que hacen posible comprender la participación de las personas transgénero en el deporte. Como fuente de inspiración, miramos la "carta", ampliamente difundida en las redes sociales, por la ex atleta Ana Paula Henkel. La carta revela la posición opuesta del ex atleta a la participación de la atleta trans Tifanny Abreu en la Superliga nacional de voleibol, con un uso argumentativo de una manera erística que ignora los conceptos discutidos y difundidos en el entorno deportivo y académico. En este sentido, podemos sospechar que este tema ha suscitado debates limitados al discurso biomédico y sin tener en cuenta el contexto sociocultural de la inserción de estos atletas. Finalmente, es importante enfatizar la necesidad de nuevas investigaciones sobre el tema para monitorear cuidadosamente los límites y las posibilidades de participación trans en el deporte.

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Abstract: Introduction: This research aims to understand the current knowledge on the health of the transgender population in the Brazilian Journal of Medical Education. Historically, the formation in medicine was consolidated in the Cartesian discourses: the figure of the white man, heterosexual and cisgender. Method: This is a qualitative and retrospective research, which also aims to problematize the medical education and the importance of Queer Studies. A documental analysis was carried out to identify the content in the conceptual constructs of the documents published between 2008 and 2017. The content analysis method according to Bardin was then chosen. Results: The methodological management indicated four categories for study: knowledge about the sexuality of medical students; gender as a research variable; gender and education; training and sexuality. Conclusion: The analyzed material indicates the lack of publications on the health of people whose gender identity is considered as dissident. The need for editorial opening is pointed out, with the purpose of providing visibility to the demands of the transgender population in the journal, aiming to broaden the discussions on the integral health of the LGBTTQIA+ population during graduation.

Resumo: Introdução: Este artigo visa compreender o conhecimento circulante na Revista Brasileira de Educação Médica sobre a saúde da população transgênera. Historicamente, a formação em Medicina consolidou-se nos discursos cartesianos interlocutados pela figura do homem branco, heterossexual e cisgênero. Método: Configura-se como uma pesquisa qualitativa, retrospectiva e descritiva, que tem como objetivo problematizar também o currículo de formação médica e a importância de uma educação pautada na ótica dos estudos Queer. Realizou-se uma análise documental para identificar o teor nos construtos conceituais dos documentos publicados de 2008 a 2017. Em seguida, foi escolhido o método de análise de conteúdo por Bardin. Resultados: O manejo metodológico indicou quatro categorias para estudo: conhecimento sobre sexualidade de estudantes de medicina; gênero como variável de pesquisa; gênero e formação; capacitação e sexualidade. Conclusões: O material analisado aponta a ausência de publicações sobre a saúde de pessoas cuja identidade de gênero é considerada como dissidente. Aponta-se a necessidade de abertura editorial, com a finalidade de proporcionar a visibilidade às demandas da população transgênera, na revista, visando ampliar as discussões sobre a saúde integral da população LGBTTQIA+ na graduação médica.

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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.

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ABSTRACT Objective: to analyze the female transsexual identity and the emergence of transfeminism through the context of vulnerability to HIV / AIDS in light of the Queer Theory. Method: a qualitative, descriptive, exploratory study based on the Queer Theory, carried out in a reference hospital for HIV/AIDS in the State of Pernambuco (Brazil), developed with six young transsexual women. The interviews were analyzed in the IRaMuTeQ software via the similarity analysis method. Results: the relation of male domination through the subordination of the transsexual woman, which originates in the binary, sexist and male chauvinistic heteronormative model, is emphasized. The context of vulnerability to HIV / AIDS is evidenced as a naturalized phenomenon of violence to the young "queer" woman, especially with precarious living conditions, history of family rejection, sexual violence and informal prostitution work. Lack of support from the social network and the imminent risk of transphobic violence result in damage to their physical and mental integrity. The following categories were observed: Emergence of transfeminism through symbolic violence and female transsexual identity and the context of vulnerability. Conclusion: the social impacts of the minimal state policy, social class cohesion (binarism, sexism, racism and male chauvinism), unequal social capital and culture of abjection of transsexual women reflect the context of the HIV / AIDS epidemic and inequalities that result in individual, contextual and programmatic vulnerability and in factors which limit the attainment of a healthy life.

RESUMEN Objetivo: analizar la identidad transexual femenina y la emergencia por el transfeminismo mediante el contexto de vulnerabilidad al HIV/SIDA a la luz de la Teoría Queer. Métodos: estudio cualitativo, descriptivo, exploratorio, fundamentado en la Teoría Queer, realizado en un hospital de referencia para el HIV/SIDA del estado de Pernambuco (Brazil), desarrollado con seis mujeres transexuales jóvenes. Las entrevistas realizadas se analizaron en el software IRaMuTeQ a través del método de análisis de similitud. Resultados: se destaca la relación de dominación masculina mediante la subordinación de la mujer transexual, que tiene su origen en el modelo de heteronormatividad binaria, sexista y machista. Se evidencia un contexto de vulnerabilidad hacia el HIV/SIDA como un fenómeno naturalizado de violencia a la mujer "queer" joven, principalmente en condiciones precarias de vida, con un historial de rechazo familiar, violencia sexual y trabajo informal en la prostitución. La falta de soporte de la red social y el riesgo inminente a la violencia transfóbica resultan en daños a su integridad física y psíquica. Se pudieron observar las siguientes categorías: Emergencia por transfeminismo mediante la violencia simbólica, e Identidad transexual femenina y el contexto de vulnerabilidad. Conclusión: los impactos sociales de la política de estado mínimo, la cohesión de las clases sociales (binarismo, sexismo, racismo y machismo), el capital social desigual y la cultura de abyección a la mujer transexual, refleja el contexto de acometimiento por la epidemia del HIV/SIDA y las desigualdades que derivan en la vulnerabilidad individual, contextual y programática y en los factores limitantes para el alcance de una vida saludable.

RESUMO Objetivo: analisar a identidade transexual feminina e a emergência pelo transfeminismo mediante o contexto de vulnerabilidade ao HIV/aids à luz da Teoria Queer. Método: estudo qualitativo, descritivo, exploratório, fundamentado na Teoria Queer, realizado em um Hospital de referência para HIV/aids do estado de Pernambuco, desenvolvido com seis mulheres transexuais jovens. As entrevistas realizadas foram analisadas no software IRaMuTeQ pelo método da análise de similitude. Resultados: ressalta-se a relação de dominação masculina mediante a subordinação da mulher transexual, que tem origem no modelo heteronormativo binário, sexista e machista. Evidencia-se o contexto de vulnerabilidade ao HIV/aids como um fenômeno naturalizado de violência à mulher "queer" jovem, sobretudo com condições precárias de vida, histórico de rejeição familiar, violência sexual e trabalho informal na prostituição. A falta de suporte da rede social e o risco iminente à violência transfóbica resultam em danos à sua integridade física e psíquica. Observou-se as seguintes categorias: Emergência por Transfeminismo mediante a violência simbólica e Identidade transexual feminina e o contexto de vulnerabilidade. Conclusão: os impactos sociais da política de estado mínimo, coesão das classes sociais (binarismo, sexismo, racismo e machismo), capital social desigual e cultura de abjeção à mulher transexual, reflete o contexto de acometimento pela epidemia do HIV/aids e desigualdades que resultam na vulnerabilidade individual, contextual e programática e nos fatores limitantes para o alcance da vida saudável.

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RESUMO A alteração do nome e do registro da pessoa transexual pode afetar a esfera jurídica de terceiros com os quais têm ou tiveram vínculo jurídico. Neste artigo, abordam-se os possíveis conflitos entre a pessoa transexual requalificada e terceiros que poderiam resultar em seus registros alterados, como os descendentes e ex-cônjuges. A partir de uma análise de conflitos hipotéticos, conclui-se que, embora formalmente caiba ao juiz encontrar a solução do conflito a partir de uma hermenêutica adequada, não há uma única solução. Assim, a ponderação dos princípios ocorrerá somente diante da situação concreta sub judice, não podendo o magistrado descurar do fato de que entre suas funções está a proteção dos direitos humanos.

ABSTRACT Changing the name and civil registration of the transgender person may affect the legal sphere of third parties with whom they have or had legal ties. This article discusses he possible conflicts that may involve the requalified transgender person and third parties that could result in their altered civil records, such as descendants and former spouses. Based on an analysis of hypothetical hypotheses, it can be concluded that while it is formally up to the judge to find a conflict resolution through an appropriate measure, there is no single solution.