Browsing by Author "Aristegui, Ines"

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    Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina
    (2021-02-03) Zalazar, Virginia; Frola, Claudia; Gun, Ana; Radusky, Pablo; Panis, Natalia k; Cardozo, Nadir F; Fabian, Solange; Duarte, Mariana I; Aristegui, Ines; Cahn, Pedro; Sued, Omar
    Background: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. Methods: A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. Results: We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. Conclusions: Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.
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    Avances en la construcción del Inventario de Estigma relacionado con el VIH (IE-VIH) en Buenos Aires, Argentina
    (2018-05) Radusky, Pablo; Zalazar, Virginia; Aristegui, Ines; Sued, Omar; Mikulic, Isabel María
    La expresión del estigma relacionado con el VIH, siendo culturalmente determinada, ha sufrido cambios a través de las décadas, asumiendo formas más sutiles, aunque igualmente perjudiciales. Por consiguiente, con el fin de medir este constructo, deben ser desarrollados nuevos instrumentos más actualizados y que capturen sus particularidades en contextos específicos. Tres dimensiones del estigma son reconocidas por los principales marcos teóricos: internalizado, anticipado y experimentado. Los objetivos de este estudio fueron explorar el funcionamiento de un conjunto inicial de ítems de un nuevo instrumento para medir estigma, obtener evidencia de confiabilidad y validez del instrumento y describir los niveles de estigma en personas con VIH adultas del Área Metropolitana de Buenos Aires (AMBA). Cinco expertos evaluaron la claridad, relevancia y validez de contenido de 88 reactivos preliminares. Una versión depurada de 77 ítems fue administrada a una muestra piloto. El análisis estadístico incluyó el análisis descriptivo de los ítems, alfas de Cronbach para establecer la confiabilidad y correlaciones con la Escala de Estigma de VIH, para verificar la validez de criterio. La muestra final consistió en 46 personas con VIH, adultas, residentes en el AMBA (67% hombres, 31% mujeres y 2% mujeres transgénero). La media de edad fue de 41 años (DE = 10.68). Cincuenta ítems con adecuada asimetría, curtosis y correlación ítem-total fueron conservados. Las escalas mostraron buena confiabilidad: Internalizado.86; Anticipado = .85 y Experimentado = .86. Cada escala correlacionó positiva y significativamente con su criterio. Se hallaron niveles más elevados de estigma anticipado, que de estigma internalizado y experimentado. Este nuevo instrumento diseñado para medir estigma relacionado con el VIH considerando sus particularidades locales, ha demostrado adecuada confiabilidad y validez, en esta primera etapa de su construcción. La etapa siguiente consistirá en un análisis factorial con una muestra de mayor tamaño con el fin de incrementar la evidencia de validez.
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    Correlates of depressive symptoms in transgender women initiating HIV treatment in Argentina
    (Wolters Kluwer Health, 2022) Aristegui, Ines; Radusky, Pablo; Zalazar, Virginia; Cardozo, Nadir; Fabian, Solange; Duarte, Mariana; Frola, Claudia; Cahn, Pedro; Sued, Omar
    Objective: To assess efficacy and safety of dolutegravir (DTG) + lamivudine (3TC) vs. DTG + tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in treatment-naive adults with HIV-1 in the prespecified 144-week secondary analyses of GEMINI-1 and GEMINI-2. Design: Identical, multicenter, phase III, randomized, non-inferiority studies (double-blind through 96 weeks). Methods: Participants with HIV-1 RNA ≤500 000 copies/ml and no major viral resistance mutations to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, or protease inhibitors were randomized 1:1 to once-daily DTG + 3TC or DTG + TDF/FTC. Results: At week 144, DTG + 3TC (N = 716) was noninferior to DTG + TDF/FTC (N = 717) in proportion of participants achieving HIV-1 RNA <50 copies/ml (Snapshot algorithm) in the pooled analysis (82% vs. 84%, respectively; adjusted treatment difference [95% confidence interval (CI)], −1.8% [−5.8, 2.1]), GEMINI-1 (−3.6% [−9.4, 2.1]), and GEMINI-2 (0.0% [−5.3, 5.3]). Twelve DTG + 3TC participants and nine DTG + TDF/FTC participants met protocol-defined confirmed virologic withdrawal (CVW) criteria; none developed treatment-emergent resistance. One DTG + 3TC participant who did not meet CVW criteria developed M184V at week 132 and R263R/K at week 144, conferring a 1.8-fold change in susceptibility to DTG; non-adherence to therapy was reported. Significantly fewer drug-related adverse events occurred with DTG + 3TC vs. DTG + TDF/FTC (20% vs. 27%; relative risk [95% CI], 0.76 [0.63–0.92]). Renal and bone biomarker changes favored DTG + 3TC. Conclusions: Three-year durable efficacy, long-term tolerability, and high barrier to resistance support first-line use of DTG + 3TC for HIV-1 treatment (see Supplemental Digital Content 1, https://links.lww.com/QAD/C297; video abstract).
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    Crecimiento postraumático en hombres gays con VIH en Buenos Aires, Argentina
    (2021-11-05) Radusky, Pablo; Zalazar, Virginia; Aristegui, Ines
    Este estudio cualitativo tuvo como objetivo explorar los significados atribuidos al virus de inmunodeficiencia humana (VIH) y la experiencia de cambios positivos posteriores al diagnóstico (crecimiento postraumático) en hombres gays de Buenos Aires, Argentina. Se efectuaron catorce entrevistas individuales en profundidad. Se implementó un análisis temático asignando códigos a fragmentos de transcripciones y organizándolos en temas. La edad media de los participantes fue de 41.29 (D.E.=11.97) y una media de 8.42 (D.E.=7.08) años desde el diagnóstico, tres de los cuales lo habían recibido en el último año. La mayoría informó cambios positivos que atribuyeron al diagnóstico de VIH, los que se organizaron en tres temas: Cambios en la filosofía de vida, Cambios en las relaciones con los otros y Cambios en la percepción de sí mismos. Algunos de estos incluyen mayor aprecio por la vida y su salud, incremento de comportamientos más saludables, fortalecimiento de la red de apoyo social y conciencia de sus capacidades para el afrontamiento. Tales cambios parecen asociarse a la atribución al VIH de sentidos más favorables. La identificación de crecimiento postraumático puede orientar intervenciones psicoterapéuticas y psicosociales dirigidas a hombres gays con VIH en virtud de que funciona como un recurso para afrontar el
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    Cultura y valores en el proceso de discriminación de las personas transgénero
    (2015) Aristegui, Ines
    La Psicología Social y Cultural estudia la interrelación entre los aspectos culturales y los procesos psicológicos, convirtiéndose en un enfoque apropiado para explorar cómo la cultura de un país y los valores individuales de sus ciudadanos se relacionan con los procesos de estigma y discriminación vividos por la población transgénero. A tal fin, el presente ensayo primero describe brevemente las dimensiones culturales de Hofstede y la Teoría de los Valores Básicos de Schwartz. Seguidamente, analiza la relación entre cultura y prejuicio en general y el conflicto intergrupal con la población transgénero en particular. Se describe como la transgresión a las creencias y valores culturalmente compartidos, así como a las normas establecidas acerca de lo masculino y femenino, es el principal atributo estigmatizante de la población transgénero. Así, se presenta cómo la Ley de Identidad de Género, en tanto cambio en las normas que justifican las acciones de los individuos, promueve cambios en las creencias y patrones de conducta de los individuos, que depararán en una mejora de la calidad de vida de las personas transgénero y en una disminución de las situaciones de estigma y discriminación. Asimismo, se describe cómo la promoción y la educación en valores que faciliten el respeto y la aceptación de “los otros”, durante el proceso de socialización familiar y escolar, servirían como herramientas para contrarrestar el estigma. Del mismo surge la necesidad de generar políticas educativas que promuevan valores asociados a la apertura al cambio y la auto-trascendencia ya que tienden a promover la búsqueda por lo novedoso, el juicio independiente así como el respeto por la igualdad y el bienestar de los otros.
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    Cumplimiento y satisfacción con el aislamiento durante la pandemia de COVID-19 en Argentina y exploración de su impacto psicológico
    (2021) Radusky, Pablo; Yamamoto, Cleyton; Feijoo-Cid, María; Sued, Omar; Aristegui, Ines
    Como respuesta a la propagación de la pandemia de COVID-19, Argentina implementó el aislamiento social, preventivo y obligatorio (ASPO). Este estudio analizó factores asociados con el cumplimiento y la satisfacción con el ASPO a 30 días de su implementación en Argentina e indagó en las respuestas emocionales autoinformadas a esta medida. Una encuesta en línea, diseñada ad hoc, fue respondida por 2965 participantes de los 24 distritos del país entre el 18 y el 21 de abril de 2020. El 68,4% (n = 2021) eran de género femenino y el 31,6% (n = 935) masculino. La media de edad fue de 43,49 años (DE = 14,97). Se realizaron pruebas de chi-cuadrado y análisis de regresión logística para explorar asociaciones entre diferentes variables y los niveles de cumplimiento y satisfacción. Las respuestas emocionales se analizaron cualitativamente. Pertenecer a un grupo en riesgo para COVID-19, haber experimentado una reducción en los ingresos del hogar y una mayor satisfacción con el ASPO se asociaron con mayores probabilidades de cumplimiento total. La menor satisfacción se asoció con ser de género masculino, pertenecer a un grupo en riesgo para COVID-19, priorizar la economía tanto como (o más que) la salud, y haber experimentado una reducción en los ingresos del hogar. Las respuestas emocionales reportadas con mayor frecuencia estuvieron relacionadas con la ansiedad y el afecto negativo o deprimido, aunque también se mencionaron estrategias de afrontamiento y emociones positivas. Estos resultados contribuyen a generar recomendaciones para mejorar la efectividad en la implementación de estas medidas para el control de la pandemia de COVID-19.
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    De la Psicopatología a la Diversidad: Salud Mental en Personas Trans Adultas. Perspectivas en Psicología
    (2020-06-29) Aristegui, Ines; Zalazar, Virginia; Radusky, Pablo; Cardozo, Nadir
    Las personas transgénero muestran prevalencias de problemas de salud mental significativamente muy superiores a las del resto de la población. Esto se debe, en gran parte, al estigma y la discriminación que padecen y al contexto de vulnerabilidad psicosocial en el que están insertas. El objetivo de este trabajo es presentar una sistematización y síntesis de los hallazgos científicos más recientes y relevantes acerca de la salud mental en personas transgénero, a nivel internacional y local. En primer lugar, se analizan los cambios ocurridos en las categorías diagnósticas en el sentido de la despatologización de las identidades trans. A continuación, se exponen las prevalencias más actuales acerca de problemas de salud mental en esta población, así como los principales factores de riesgo y protección que impactan en su desarrollo. Finalmente, se discuten las limitaciones más significativas de los estudios disponibles en salud mental en personas transgénero en el contexto regional y los vacíos existentes en el conocimiento en esta área, realizando recomendaciones para futuras líneas de investigación. Se espera que este trabajo contribuya a la actualización de los profesionales de la salud mental que asisten a población transgénero, desde una perspectiva científica, promoviendo una atención sanitaria libre de estigma y discriminación y reduciendo barreras al acceso de las personas transgénero a los servicios de salud.
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    Design and Development of an Electronic Health Record According to Argentine Gender Identity La
    (2022-06) Giraldo, Liliana; Fink, Valeria; Cahn, Florencia; Aristegui, Ines; Caceres, Betiana; Sued, Omar; Cesar, Carina
    Health information systems face the challenge of collecting data on patients’ gender identity. The absence of this information may lead the patients to situations of vulnerability and discrimination. The objective of this study is to describe the process of designing and developing an Electronic Health Record according to the Argentine Gender Identity Law. This health record allows clinics to record legal names and surnames, other social names, gender identity, sex at birth, and legal sex.
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    Detection of antiretrovirals in transgender women with HIV is not altered by hair treatments
    (Wolters Kluwer Health, 2023-11) Rodriguez Violeta J; Alcaide, Maria Luisa; Sued, Omar; Aristegui, Ines; Radusky, Pablo; Kozlova, Sofia; Cardozo, Nadir; Dell’Isola, Emanuel; Gandhi, Monica; Jones, Deborah L.
    This study evaluated the detection of ARVs in hair samples from TW with HIV in Argentina. Results suggest that hair collection is acceptable to TW; that adherence measured by detection of ARVs in hair was high; and that ARVs can be detected in hair even in the context of hair treatments.
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    Diagnóstico y tratamiento del trastorno bipolar en población transgénero
    (2014) Aristegui, Ines
    A medida que se supera la idea de que personas transgénero sufren de una patología con los nuevos lineamientos del DSM–5 (la 5ta edición del Manual Diagnóstico y Estadístico de los Trastornos Mentales) y se alcanza el reconocimiento de sus derechos en un marco legal como la Ley de Identidad de Género en Argentina, se espera que las personas transgénero se acerquen a los servicios de salud en general y de atención psicológica en particular. Este artículo presenta una revisión de las investigaciones existentes sobre la prevalencia, el diagnóstico y el tratamiento del trastorno bipolar en población transgénero. Se realiza un recorrido por las nuevas definiciones del DSM–5, se analizan las dificultades y se presentan consideraciones para su diagnóstico y tratamiento. Debido a los altos índices de depresión, intentos de suicidios y abuso de sustancias presentes en esta población, se estima que existe una alta prevalencia del trastorno bipolar, pero que esta enfermedad no es debidamente diagnosticada ya sea porque las personas transgénero no acceden a los servicios de salud o bien porque algunos de sus síntomas se confunden con las características de los estilos de vida que muchas personas llevan. De la revisión bibliográfica se desprende el requisito de realizar estudios locales para conocer las características de la población transgénero en Argentina, así como la necesidad de capacitar y sensibilizar a los profesionales de la salud mental sobre las problemáticas específicas de estas poblaciones.
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    Do Transgender People Respond According to Their Biological Sex or Their Gender Identity When Confronted With Romantic Rivals?
    (2019) Aristegui, Ines ; Castro Solano, Alejandro; Buunk, Abraham P
    This study examined the hypothesis that gender identity and biological sex represent independent modules and that transgender individuals respond to romantic rivals in line with their gender identity and not with their biological sex. Additionally, associations of jealousy with intrasexual competitiveness (ISC) and social comparison orientation (SCO) were explored. A total of 134 male-to-female and 94 female-to-male transgender individuals from Greater Buenos Aires, Argentina, responded to a questionnaire. In line with the predictions, female-to-male transgender individuals experienced more jealousy than male-to-female transgender individuals in response to a physically dominant rival, whereas male-to-female individuals experienced more jealousy than female-to-male individuals in response to a physically attractive rival. Regardless of their gender identity, in both groups social-communal attributes were the most jealousy-evoking characteristic. Overall, the results indicate that transgender individuals mainly respond in line with their gender identity and not in line with their biological sex when facing romantic rivals. In addition, transgender individuals high in ISC experienced relatively more jealousy in response to all rival characteristics, whereas SCO was only among male-to-female individuals associated with jealousy.
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    El impacto del estigma y la discriminación en la calidad de vida de personas transgénero viviendo con VIH.
    (2013) Aristegui, Ines ; Vazquez, Mariana
    The improvement of quality of life has become a fundamental objective of social policies and an essential element in the treatment of chronic diseases. Transgender people have the highest level of social vulnerability and the highest HIV prevalence. A qualitative study was conducted in order to explore perceptions and experiences of stigma and discrimination and their impact on quality of life among a group trans women living with HIV. Ten individuals from different regions of the country participated in a discussion group. Results show that trans people are systematically excluded from their families and the educational, labor, legal and health systems. These people’s welfare and wellbeing is below expectations due to stigma and its consequences. However, the subjective well-being seems to be positively influenced by social support and participation in peer groups. Implications of these results for policy makers are presented in the discussion.
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    Encuesta sobre el impacto de la pandemia COVID-19 en el consumo de medicamentos, drogas recreativas y bebidas alcohólicas en Argentina
    (2021-05-05) Sciannameo, Sergio; Zalazar, Virginia; Aristegui, Ines; Parera, Daniela; Sued, Omar
    Objetivos: El objetivo del estudio fue evaluar el comportamiento en el uso de medicamentos, drogas recreativas y el consumo de bebidas alcohólicas en la población argentina durante el transcurso del ASPO (Aislamiento Social, Preventivo y Obligatorio) por la pandemia de la Covid-19. Métodos: Se diseñó ad hoc una encuesta on-line disponible entre el 28 de junio y el 9 de julio del 2020 mediante Surveymonkey© difundida por redes sociales. Se realizaron análisis univariados y bivariados. Resultados: El 43,6% de los 2.906 participantes reportó utilizar medicamentos para enfermedades crónicas. Se observó una diferencia significativa (p=,000) en la disminución del consumo entre quienes se atienden en efectores públicos (17,9%) y quiénes lo hacen en la medicina privada (7,2%). Asimismo, se encontró una diferencia significativa en la disminución del acceso por la zona de residencia (p=,031), siendo menor en Ciudad de Buenos Aires (6,8%) que en el resto del territorio nacional (10,6%). Del total de individuos encuestados, el 38,3% refiere haberse automedicado durante el ASPO, de estos el 59,3% no alteró su rutina de auto-medicación, el 15% disminuyó su consumo y el 25,7% lo aumentó. El 23,9% de la muestra manifestó consumir drogas recreativas. El 47,8% de los usuarios informó haber aumentado el consumo. Asimismo, el 66,3% informó tomar alcohol regularmente, y de éstos, el 40,1% aumentó su consumo. Conclusiones: Es importante continuar la atención de las enfermedades crónicas, la salud mental y el uso de sustancias. En particular reforzando el sistema público de salud y del interior del país.
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    Engaging female sex workers in their health care through stakeholder mapping and participatory analysis in Buenos Aires, Argentina
    (2024-04) Esandi, Maria Eugenia; Walmsley, Sharon; Zalazar, Virginia; Panizoni, Estefania; Serrao, Camila; Acuña, Rodrigo; Frontini, Emilia; Zeltman, Ana Clara; Trejo, Maria Celia; Cardozo, Nadir; Romero, Marcelo; Orellano, Georgina; Ortiz, Zulma; Loutfy, Mona; Duran, Adriana; Cahn, Pedro; Aristegui, Ines; Fink, Valeria; MAS por Nosotras Study Group
    Cis and trans female sex workers (FSW) face marginalization and struggle to access sexual and reproductive health and rights (SRHR) services. The COVID-19 pandemic worsened these disparities. January-April 2023, we conducted stakeholder mapping (SM) with SRHR policies and programs decision-makers, implementers and users in Buenos Aires, Argentina. This strategy aims to identify, classify and categorize stakeholders based on the power and agreement level of SRHR policies and plans implemented during the pandemic. A qualitative study was conducted through focus groups with FSW and interviews with healthcare providers analyzed with the DEPICT model (methodology for collaborative data interpretation with the community) to investigate facilitators and barriers from their perspectives. Considering the challenges in identifying the appropriate stakeholders, this approach became crucial. The landscape is dynamic, influenced by the sociopolitical context, and recent shifts in government. Following SM, we categorized 147 stakeholders Supporters (68%) and promoters (16%) outnumbered blockers (10%), observers (3%) and neutral (3%) in implementing new policies aimed at SRHR services for FSW. The qualitative interviews revealed barriers including the pervasive impact of intersectional stigma and discrimination, violence, failures in intersectoral articulation and coordination, and difficulties in scheduling of appointments for SRHR services. Facilitators identified improvements in transgender healthcare services in the last decade and the emergence of community assets as pivotal, particularly during the pandemic. SM was invaluable for identifying and characterizing the priorities of key stakeholders for designing policies affecting SRHR services. The inclusion of community perspective, while challenging, enriched our understanding of barriers and facilitators while empowering the community to express their needs. Despite structural barriers and challenges posed by the pandemic, community organizations have displayed resilience, emerging as a vital support system for FSW. We highlight the importance of collaborative efforts and comprehensive approaches in addressing the unique needs of FSW in Argentina and similar contexts.
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    Ethics and the treatment as prevention strategy among transgender women living with HIV in Argentina
    (2021-05) Zalazar, Virginia; Aristegui, Ines; Socías, M Eugeni; Cardozo, Nadir; Sued, Omar; Shannon, Kate; Duff, Putu
    While numerous ethical concerns have been voiced regarding HIV service scale-up strategies targeting key populations, few studies have examined these from the perspective of affected groups. This study therefore sought to understand transgender women's experiences and perspectives of targeted HIV services scale-up in the context of Argentina's Treatment as Prevention strategy. In 2016, 25 purposively selected transgender women living with HIV were interviewed by a peer research associate. Interviews were audio recorded, transcribed verbatim and analysed using participatory coding techniques. Findings suggest that procedures around informed consent, including the provision of full information in lay language and voluntariness, were lacking both pre- and post-HIV test. Further, many transgender women felt disrespected and disregarded by healthcare workers. While the majority of participants were unaware of Treatment as Prevention, once explained, most felt the approach was ethical overall, and helped improve equity in HIV service access. Study findings offer several community-driven suggestions to support patient rights and the ethical scale-up of HIV services for transgender women in Buenos Aires, including the need for training in and the provision of non-judgemental, gender-affirmative care and the inclusion of peer-navigators.
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    Evaluation of a Sexuality Education Program: A Peer-Led HIV Prevention Intervention in Argentina
    (2017-03) Brizuela, Viviana; Aristegui, Ines; Caceres, Betiana
    Between 2010-2014, Fundacion Huesped and the Youth for Health Network implemented a sexuality education program, dance4life, in public schools in Argentina. A process evaluation was conducted in 2014 to assess the implementation of the program between 2010 and 2013, and make preliminary assessments of the impact on youth sexual and reproductive health. A mixed-methods approach (qualitative-quantitative), using validated tools and frameworks, was applied through self-reported surveys, semi-structured interviews, and focus groups with students, peer educators, teachers, and staff. This was complemented by a desk review of past reports and program-related documents. The program successfully trained over 2,000 “agents4change” (youth facilitators) over the four year period. The experiences reported were generally positive, highlighting peer-education as the most novel and attractive component for all the stakeholders. Educators and young people reported that the fact that this was a global program with international involvement was one of the positive aspects. 93% of respondents correctly identified modes of HIV transmission. Correct knowledge on contraceptive use was also high: 68% for the injectable; 99% for the condom. Positive changes in attitude were reported: 72% of respondents indicated great change in their respect for people living with HIV, and 60% in their capacity to openly talk about sexuality (60%). 80% said they knew how to avoid unwanted sex. Although the dance4life program had overall positive results, including increasing awareness of sexuality and confidence in decisions about sex, there are issues that would need to be addressed: e.g. project sustainability assuring lasting effects on school culture, and health system integration to improve health outcomes. Having baseline and monitoring data is critical to compare changes in young people’s knowledge, attitudes, and practices about sex and HIV.
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    Examining Factors Associated with Gender Identity Among Individuals Disengaged from HIV Care in Argentina
    (2021-05-06) Radusky, Pablo; Aristegui, Ines ; Mandell, Lissa N; Dell'Isola, Emanuel; Zalazar, Virginia; Cardozo, Nadir; Alcaide, María L; Weiss, Stephen M; Jones, Deborah L; Sued, Omar
    Background: Transgender women (TGW) consistently show lower adherence to antiretroviral treatment (ART), than cisgender people (CP) living with HIV. This study examined sociodemographic and psychosocial factors associated with gender identity among individuals disengaged from HIV care in Argentina. Methods: Data for this study was obtained at baseline from the Conexiones y Opciones Positivas en la Argentina 2 (COPA2) study. Forty-one TGW and 360 CP (177 male, 183 female) disengaged from HIV care completed questionnaires assessing sociodemographic information, severity of depressive symptoms, substance and alcohol use, patient-provider relationship quality, self-efficacy, ART adherence motivation, self-reported adherence, and treatment-related factors. Analyses included chi-square tests exploring the association between categorical variables and gender identity, and ANCOVAs comparing groups controlling for age. Results: Being a TGW was associated with having only public health insurance; substance use, particularly cocaine; substance-related problems; and hazardous drinking. TGW showed more negative consequences related to substance use, more hazardous alcohol use, lower patient-provider relationship quality, and lower self-reported adherence, than CP. Conclusions: Harm reduction should be a key component in HIV care for TGW to address substance use. Health care teams should receive formal training in patient-provider communication skills and trans-specific competencies to enhance TGW's adherence and retention. Public policies to address structural factors that negatively affect TGW's adherence to ART are also needed.
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    Factores contextuales, sociales e individuales como barreras y facilitadores para el acceso a la salud de mujeres trans: desde la perspectiva de la comunidad
    (2018-12) Zalazar, Virginia; Aristegui, Ines; Cardozo, Nadir; Sued, Omar; Rodríguez, Allan E.; Frola, Claudia; Pérez, Héctor
    Background: Transgender women (TGW) are vulnerable to several health problems, including HIV and other STDs, which significantly reduces their life expectancy. Therefore, there is an urgent need to understand factors affecting access to healthcare. Methods: A qualitative study was conducted among TGW living in rooming houses (TRH) in Buenos Aires. The objective of the study was to explore contextual, social and individual barriers and facilitators to access healthcare, particularly HIV services, and the acceptability of interventions. Two focus groups and five interviews were conducted in three TRH. Results: Contextual barriers described were the limited number of appointments and long waiting hours. Social obstacles included health workers’ stigma and discrimination and blaming of TGW for their health burdens, as well as HIV stigma within TGW groups. Most important facilitator were inclusive services. Individual barriers were self-exclusion and anticipated stigma, resulting in high rates of self-medication and industrial silicone injection. Peers play an important role by accompanying others TGW to healthcare. While reporting similar problems, TGW recommended different interventions according to their THR profile. Conclusions: As the stigma and discrimination is the most important barrier, it is imperative to ensure awareness of transgender issues for all personnel of healthcare services. It is necessary to implement a wide range of strategies in health facilities, and evaluate the community acceptance of domiciliary interventions, in order to respond to the different demands of this population.
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    Female sex workers and police violence during the Covid-19 health crisis in 2020-21: Results from the EPIC multi-country community-based research program in Argentina
    (2022) Aristegui, Ines; Castro Avila, Jorge; Villes, Victoria; Delabre, R. M.; Orellano, Gonzalo; Aguilera, Marcelo; Romero, Maria; Riegel, Luis; Kretzer, Lucas; Cardozo, Nadir; Radusky, Pablo; Rojas Castro, Diego
    Background Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. Methods EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020–April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. Results Among 173 respondents, median age was 34 [IQR 27–42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. Conclusions FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.
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    High Willingness to Use HIV Pre-Exposure Prophylaxis Among Transgender Women in Argentina
    (2016-12-01) Zalazar, Virginia; Aristegui, Ines; Kerr, Thomas; Marshall, Brandon D L; Romero, Marcela; Sued, Omar; Socias, Maria E.
    Fil: Sued O. Fundación Huésped, Buenos Aires; Argentina