Low awareness of HIV status and high proportion of recent infections among young travestis and trans women in Brazil.

Résumé

INTRODUCTION: This study examined correlates of new HIV diagnosis (i.e., no prior awareness of HIV-positive status and HIV diagnosis at study entry) and identified factors associated with HIV vulnerability among Brazilian young trans women.MATERIAL AND METHODS: Baseline assessment of Brilhar e Transcender (BeT ["Shine and Transcend" in English]), an HIV status-neutral intervention single-center study using peer-led digital and in-person systems navigation, between February‒July 2022, in Rio de Janeiro, Brazil. Trans women aged 18‒24 years, living in Rio de Janeiro city or the metropolitan area, were eligible if they were not currently on HIV Pre-Exposure Prophylaxis (PrEP) for those who were HIV-negative, or if they were not on antiretroviral therapy, had a detectable viral load, or were not linked to HIV care for those living with HIV.RESULTS: Among 170 potential participants, 164 young trans women were eligible and enrolled. Among these, 13% (n = 22) were living with HIV, 68% of them (n = 15) were unaware of their HIV status and diagnosed with HIV; 33% (n = 4 of 12) had a recent HIV infection. Overall, 23.1% had current syphilis, 15% rectal chlamydia, and 13% rectal gonorrhea. Younger age (18‒19 years) (adjusted Odds Ratio [aOR=5.62], 95% Confidence Interval [95% CI 1.36‒27.22]), lower educational attainment (aOR = 7.99, 95% CI 1.78‒47.85), and moderate/high risk of crack/cocaine use (aOR = 8.6, 95% CI 1.44‒54.91) were associated with a higher odds of a new HIV diagnosis.CONCLUSIONS: HIV disparities among young trans women in Brazil reflect persistent structural and social inequities shaping vulnerability and access. Tailored interventions must extend prevention efforts beyond individual behaviors to address these broader determinants.