Sexual violence is associated with poor treatment outcomes among transgender women living with HIV in Brazil

Abstract

Abstract Background: Transgender (trans) 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 trans 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 trans 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 at follow-up, adjusting for baseline sociodemographic characteristics. Results: A total of 113 TWH participated in the study. At baseline, the median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% were retained in care and 35% had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 12% reduction in retention in care (RR: 0.88, 95% CI: 0.65, 1.19) and a 34% reduction in viral suppression (RR: 0.66; 95% CI: 0.40, 1.09). Lifetime sexual violence was significantly associated with a 28% reduction in retention in HIV care (RR: 0.72, 95% CI: 0.52, 0.99) and a 57% reduction in viral suppression (RR: 0.43; 95% CI: 0.23, 0.79). Conclusion: Our findings are among the first to demonstrate that lifetime experiences of sexual violence are associated with subsequent reduced likelihood of retention in HIV care and viral suppression among trans women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. Trial registration: ClinicalTrials.gov Identifier: NCT03525340