Browsing by Author "Cardozo, Nadir"

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    Análisis de la accesibilidad y la calidad de atención de la salud para la población lesbiana, gay, trans y bisexual (LGBT) en cinco regiones sanitarias de la Provincia de Buenos Aires
    (Fundación Huésped; Ministerio de Salud de la Provincia de Buenos Aires, 2017) Arístegui, Inés; Lucas, Mar; Agriano, Mariel Orive; Villalba, Lucas; Cardozo, Nadir; Zalazar, Virginia; Radusky, Pablo; Pecheny, Mario; Christel, Lucas; Neer, Anahí Farji; Godoy, Gabriel; Fernández, Sandra; Mertehikian, Yasmín; Ortega, Julián; Weisbrot, Vikki; Marentes, Maxi
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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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    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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    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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    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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    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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    Home-based HIV testing: Using different strategies among transgender women in Argentina
    (2020-03-19) Frola, Claudia; Zalazar, Virginia; Cardozo, Nadir; Vázquez, María L. Vázquez
    Background In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW. Methods A multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis. Results A total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously. Conclusions A multidisciplinary home-based HIV testing service among TGW is feasible and effective to detect cases of HIV infection. The testing algorithm should start with an RT followed by molecular diagnosis. The history of STIs and never having been tested for HIV were the factors associated with HIV-positive results and should determine efforts to reach this population. Home-based testing reaches individuals that were not tested before and who have more risk of acquiring HIV.
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    Mental health, substance use, experiences of violence, and access to health care among transgender and non-binary people during the COVID-19 lockdown in Argentina
    (2021-07) Radusky, Pablo; Cardozo, Nadir; Duarte, Mariana; Fabian, Solange; Frontini, Emilia; Sued, Omar; Aristegui, Ines
    Background: Lockdown measures are effective in controlling the spread of COVID-19; however, concerns have increased regarding their impact on transgender and non-binary people. Aims: This study describes self-reported changes in mental health, substance use, experiences of violence, and access to health care and basic services among transgender and non-binary populations from Argentina after two months of lockdown implementation. Methods: An online national survey was responded to by 182 participants (72 transfeminine [TF], 66 transmasculine [TM], 44 non-binary [NB] individuals) between May and June 2020. The questionnaire was informed by the results of focus groups, reviewed by activists, and disseminated through social media. Descriptive statistics were used to summarize the data. Results: The COVID-19 pandemic and the lockdown have had a generally negative impact on the participants. TF participants reported a greater proportion of negative changes in the socioeconomic aspect, such as a reduction in income and barriers to access basic services (housing, food, hygiene products, and financial assistance). TM and NB participants reported higher proportions of adverse psychological impact, with high frequencies of intense negative emotions and suicidal ideation. A general reduction in substance use was observed in all three groups. The most frequent source of violence in the three groups was from a family member, especially among NB participants. Half of the TF and TM individuals reported difficulties accessing or continuing their hormone therapy. TM and NB participants reported considerable barriers to accessing mental health care. Conclusion: The COVID-19 pandemic and the prolonged lockdown have had a negative impact on the transgender and NB population, exacerbating their preexisting vulnerability and exclusion. Furthermore, this impact affected each subgroup differently in a particular and specific way"¡
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    Navegadores pares como “puentes” entre las personas trans y el sistema de salud: sistematización de roles y competencias
    (2021-11) Cardozo, Nadir; Fontini, Emilia; Duarte, Mariana; Fabian, Solange; Radusky, Pablo; Zalazar, Virginia; Cahn, Susana; Sued, Omar; Aristegui, Ines
    [RESUMEN]. El estigma y la discriminación llevan a la población trans a evitar acercarse a los servicios de salud. Les navegadores pares (NP) son personas de la comunidad insertas en el equipo de salud que construyen "puentes" entre ambos. Aunque los servicios reconocen cada vez más su importancia, no hay una guía específica y su rol no está bien definido. Este trabajo sistematiza la experiencia y competencias de tres NP en un servicio de atención de VIH en Buenos Aires, Argentina. Esta sistematización resalta la necesidad tanto de incrementar el número de NP con estas competencias específicas, asignando más recursos para incorporar NP con competencias específicas en salud y replicar su rol en otros sectores, como de promover su participación en la planificación e implementación de programas para población
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    Obstáculos en la accesibilidad a los consultorios inclusivos para personas trans en la Provincia de Buenos Aires.
    (2023) Viscchio, Florencia; Radusky, Pablo; Zalazar, Virginia; Cardozo, Nadir; Santa Cruz, Lida; Pecheny, Mario; Aristegui, Ines
    El acceso a la salud para las personas trans ha sido históricamente obstaculizado por el estigma y la discriminación institucional. A pesar de los avances legales y sociales en materia de reconocimiento de derechos de los últimos años, todavía se identifican barreras para su efectivo cumplimiento. Este trabajo tuvo como objetivo describir las principales barreras en la accesibilidad a los consultorios inclusivos (CI) y analizar las necesidades específicas de la población trans que se atiende en la provincia de Buenos Aires (PBA). MÉTODOS: Se presenta un subanálisis de un estudio cualitativo más amplio realizado en 2017, cuyo objetivo fue relevar información sobre demandas sanitarias, accesibilidad y calidad de atención de los servicios de salud específicos para población de lesbianas, gays, bisexuales y trans (LGBT) en ocho efectores de la PBA. La muestra fue intencional, conformada por 29 entrevistas semiestructuradas a referentes y profesionales y 2 grupos focales con masculinidades y feminidades trans, respectivamente. Se realizó un análisis temático. RESULTADOS: Se identificaron barreras organizacionales y simbólicas, sobre todo en los CI que funcionan en hospitales. Entre las simbólicas, se evidencia la persistencia de prácticas patologizantes en salud mental. DISCUSIÓN: Los CI brindan una respuesta satisfactoria, pero transitoria. Es necesario transversalizar la perspectiva de género a todas las intervenciones en salud.
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    Prevalence and correlates of current cigarette smoking among transgender women in Argentina
    (University of Texas MD Anderson Cancer Center, United States, 2023-12) Cartujano-Barrera, Francisco; Mejia, Raul M.; Radusky, Pablo; Cardozo, Nadir; Duarte, Mariana; Fabian, Solange; Caballero, Romina; Zalazar, Virginia; Ramos-Pibernus, Alixida; Alpert, Ash B.; Cupertino, Ana Paula; Frola, Claudia; Aristegui, Ines
    Objective: To assess the prevalence of current cigarette smoking among transgender women in Argentina, and to examine the unique associations of current cigarette smoking with demographic and psychosocial factors. Methods: This study is a secondary data analysis of the TransCITAR – a prospective cohort study of transgender individuals living in Buenos Aires, Argentina – baseline data. The baseline survey collected information on sociodemographic characteristics, perceived health status, depressive symptoms, suicide attempts, current cigarette smoking, alcohol use disorder, and substance use. Participants were also asked about lifetime experiences of physical and sexual violence perpetrated by partners, clients and/or the police, and experiences of gender identity stigma in the past year from healthcare workers and the police. Lastly, participants were asked if they had ever been arrested. Fisher’s exact test was used to compare proportions in categorical variables and student t-test was used for continuous variables. Significant associations with current cigarette smoking were tested in a logistic regression model adjusted for all significant associations. Results: A total of 41.7% of participants (n = 393) reported current cigarette smoking. Compared to their non-smoking counterparts, participants who reported current cigarette smoking (1) had completed less education, (2) were more likely to be born in Argentina, (3) more likely to had migrated to Buenos Aires from other parts of the country, (4) more likely to report a history of sex work, (5) more likely to perceive their health as excellent, (6) more likely to screen positive for hazardous alcohol drinking, (7) more likely to report any substance and cocaine use in the past year, (8) more likely to experience gender identity stigma from the police in the past year, and (9) more likely to being arrested in their lifetime (all p’s < 0.05). After controlling for all significant associations, education level of less than high school (AOR = 1.79, 95% CI 1.02–2.12), hazardous drinking (AOR = 2.65, 95% CI 1.30–5.37), and any substance use in the last year (AOR = 2.14, 95% CI 1.16–3.94) were positively and independently associated with current cigarette smoking. Conclusion: Among transgender women in Argentina, current cigarette smoking was more than double the rate for cisgender women. Current cigarette smoking was associated with education, hazardous drinking, and any drug use. These results will inform future smoking cessation interventions among transgender women in Argentina.
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    Reduction of Gender Identity Stigma and Improvements in Mental Health Among Transgender Women Initiating HIV Treatment in a Trans-Sensitive Clinic in Argentina
    (2020-12) Radusky, Pablo; Zalazar, Virginia; Cardozo, Nadir; Fabian, Solange; Duarte, Mariana; Frola, Claudia; Cahn, Pedro; Sued, Omar; Aristegui, Ines
    Purpose: Stigma toward transgender women (TGW) increases psychosocial vulnerability, leading to poor mental health and affecting access and retention in HIV care. Trans-sensitive health care (TSHC) has the potential to mitigate this adverse impact. This study aimed to describe baseline characteristics in gender identity stigma (GIS), mental health, and substance use among TGW living with HIV initiating antiretroviral treatment and to analyze changes after 6 months in HIV care in a TSHC clinic in Argentina. Methods: Sixty-one TGW living with HIV responded to the following questionnaires at baseline and after 6 months in TSHC: sociodemographic, experiences of GIS (in health care, police, etc.), Center for Epidemiologic Studies Depression Scale (CES-D) (depression), State Trait Anxiety Inventory (STAI) (anxiety), Drug Abuse Screening Test (DAST-10) (drug use), Alcohol Use Disorders Identification Test (AUDIT) (alcohol use), 8-item Personal Wellbeing Index-Adults (PWI-A) (quality of life [QOL]), Personality Inventory for DSM-5-Brief Form (PID-5-BF) (maladaptive personality traits), and Duke Index (social support). Analyses included Pearson correlations to analyze associations between variables; and paired sample t-tests, to explore changes between baseline and 6 months. Results: A significant proportion experienced episodes of GIS the last year in any context. At baseline, 50.8% showed significant depressive symptoms and 65.6% reported any drug use in the last year. At 6 months, participants experienced a significant reduction of GIS, both enacted and internalized, anxiety, drug, and alcohol use, and improvement in QOL. The remaining mental health indicators were not significantly modified. Conclusion: A TSHC service may have a gender-affirmative impact on TGW initiating HIV care that contributes to reduce GIS and substance use and improve mental health. This highlights the importance that HIV care programs for TGW comply with trans-sensitive essential components to enhance retention.
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    Retention among transgender women treated with dolutegravir associated with tenofovir/ lamivudine or emtricitabine in Argentina: TransViiV study
    (Plos, 2023-01) Frola, Claudia; Aristegui, Ines; Figueroa, María I.; Radusky, Pablo; Cardozo, Nadir; Zalazar, Virginia; Cesar, Carina; Patterson, Patricia; Fink, Valeria; Gun, Ana; Cahn, Pedro; Sued, Omar
    In Argentina, transgender women (TGW) have a high HIV prevalence (34%). However, this population shows lower levels of adherence, retention in HIV care and viral suppression than cisgender patients. The World Health Organization (WHO) recommends the transition to dolutegravir (DTG)-based regimens to reduce adverse events and improve adherence and retention. The purpose of this study was to determine retention, adherence and viral suppression in naïve TGW starting a DTG-based first-line antiretroviral treatment (ART) and to identify clinical and psychosocial factors associated with retention. We designed a prospective, open-label, single-arm trial among ART-naïve HIV positive TGW (Clinical Trial Number: NCT03033836). Participants were followed at weeks 4, 8, 12, 24, 36 and 48, in a trans-affirmative HIV care service that included peer navigators, between December, 2015 and May, 2019. Retention was defined as the proportion of TGW retained at week 48 and adherence was self-reported. Viral suppression at <50 copies/mL was evaluated using snapshot algorithm and as per protocol analysis. Of 75 TGW screened, 61 were enrolled. At baseline, median age was 28 y/o., HIV-1-RNA (pVL) 46,908 copies/mL and CD4+ T-cell count 383 cells/mm3. At week 48, 77% were retained and 72% had viral suppression (97% per protocol). The regimen was well tolerated and participants reported high adherence (about 95%). Eleven of the fourteen TGW who discontinued or were lost to follow-up had undetectable pVL at their last visit. Older age was associated with better retention. DTG-based treatment delivered by a trans-competent team in a trans-affirmative service was safe and well tolerated by TGW and associated with high retention, high adherence and high viral suppression at 48 weeks among those being retained.
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    The Impact of Gender Identity Stigma and Mental Health on HIV Treatment Among Transgender Women in Argentina
    (Springer Publishing Company, 2022) Radusky, Pablo; Aristegui, Ines; Mandell, Lissa N.; Dell’Isola, Emanuel; Zalazar, Virginia; Cardozo, Nadir; Frola, Claudia; Jones, Deborah L.; Sued, Omar
    In Argentina, HIV prevalence in transgender women (TGW) is high while engagement in HIV treatment is low due to multiple factors: gender identity stigma (GIS), mental health problems (e.g., depressive symptoms) and substance use. This study examined the impact of these factors on HIV treatment uptake among TGW in Argentina. A sample of 79 TGW “on” and “off” treatment completed questionnaires to assess GIS, depressive symptoms (CES-D), alcohol (AUDIT) and drug use (DAST-10), suicidal ideation, HIV-related stigma (HIV Stigma Scale) and support from family. From them, 36.7% met criteria for “off” HIV treatment; 49.4%, for significant depressive symptoms; 53.2%, for hazardous alcohol use; and 29.7%, for problems related to drug use. GIS was positively associated with depressive symptoms and HIV-related stigma, both in TGW “on” and “off” treatment, and with alcohol and drug use, only in the last group. In the multivariable model, only experiences of GIS from the police were negatively associated with being “on” treatment, whereas GIS in workplaces (excluding sex work venues) were associated with increased odds of being “on” treatment. GIS, specifically from the police, has a far-reaching impact on the physical and emotional health of TGW living with HIV in Argentina, as it is associated with negative mental health indicators, substance use and suboptimal HIV care uptake.