Browsing by Author "Zalazar, Virginia"
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Item Abordaje psicológico de personas con VIH. Sistematización de la experiencia de atención psicosocial de Fundación Huésped(Fundación Huésped, 2013) Arístegui, Inés; Pemoff, Raquel; Flighelman, Mariana; Warth, Silvia; Vergani, Franca; Zalazar, Virginia; Rapagnani, Liliana; Mercado, ArturoEsta guía es el resultado de la experiencia adquirida, los aprendizajes alcanzados y los desafíos enfrentados, en todos estos años de trabajo, por el equipo de salud mental de Fundación Huésped. Consideramos este cuadernillo como una forma de compartir nuestra experiencia y esperamos sea una herramienta de ayuda para aquellos colegas que transitan por caminos similares. Sin embargo, no creemos que ésta sea la única forma de trabajar en esta temática. Aquí compartiremos, los que según nuestra experiencia, son algunos patrones comunes de comportamientos, sentimientos, pensamientos y situaciones que viven las personas con VIH - destacando la necesidad de atender a la individualidad de cada persona y su contexto – y el abordaje que utilizamos para atender su problemática. Es importante mencionar que las experiencias que estamos compartiendo aquí, se ajustan a la particularidad de las vivencias de las personas con VIH, más allá del marco teórico con el que cada profesional trabaje. Esta guía, elaborada desde el trabajo realizado por varios profesionales que han conformado este equipo y en colaboración con otras disciplinas, brindan un marco claro para la práctica, en un campo complejo de intervención.Item 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, OmarBackground: 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.Item 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, MaxiItem Assessing the Underestimation of HIV Risk Infection Among Young Men Who Have Sex with Men in Argentina(2022-11) Feijoo-Cid, Maria; Fernández-Cano, María Isabel; Zalazar, Virginia; Moriña Soler, David; García-Sierra, Rosa; Arreciado Marañón, Antonia; Sued, OmarThe aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated "factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5–11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161–121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1–3.5]) and using LSD (aOR = 5.44 [CI 95:1.32–30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.Item 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 MaríaLa 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.Item Conocimientos y actitudes sobre las Hepatitis A, B y C en población general y personal de salud en Argentina(Fundación Huésped, 2014) Arístegui, Inés; Zalazar, Virginia; Lucas, MarLas hepatitis virales son un problema de salud pública mundial. Recientemente la OMS hizo un llamado a los gobiernos a tomar acciones para prevenir, diagnosticar y tratarlas. Se estima que las hepatitis virales son responsables de 1.4 millones de muertes anuales (comparables al 1.6 millón de muertes por HIV/sida o 1.3 millones por tuberculosis). En el mundo 520 millones de personas conviven con hepatitis virales (350 con hepatitis B y 170 con hepatitis C) y 2000 millones han estado infectadas alguna vez con el virus de hepatitis B. La mayor parte de los individuos con hepatitis crónica B y C desconocen su situación y están en riesgo de transmitir la enfermedad y desarrollar cirrosis o cáncer. En Argentina, hay escasez de datos de prevalencia de estas infecciones y los pocos estudios que se han realizado, cuentan con muestras pequeñas y diferentes metodologías con variados niveles de sensibilidad y especificidad, lo cual dificulta las comparaciones. A pesar de esto, los datos informan que aproximadamente entre el 1 al 2% de la población en nuestro país podría estar infectada con hepatitis B o C, con importantes variaciones regionales: mayores tasas de hepatitis B en el noroeste y noreste; y concentración de casos de hepatitis C en ciudades como Córdoba o Buenos Aires o en diferentes grupos como personas con HIV. A partir de la escasa literatura sobre el conocimiento sobre las hepatitis en población general, surge la necesidad de realizar nuevos estudios para poder generar un mayor conocimiento en nuestro país acerca de esta temática. Se realizó un estudio exploratorio con el objetivo de evaluar los conocimientos, percepciones y creencias sobre hepatitis virales A, B y C en población general y en los profesionales de la salud. El instrumento utilizado para la recolección de datos fue un cuestionario estructurado elaborado ad hoc que constó de 14 preguntas para el público en general y 8 preguntas extras para el personal de salud. En el presente se detallan los resultados obtenidos.Item 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, OmarObjective: 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).Item Crecimiento postraumático en hombres gays con VIH en Buenos Aires, Argentina(2021-11-05) Radusky, Pablo; Zalazar, Virginia; Aristegui, InesEste 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 elItem 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, NadirLas 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.Item 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, OmarObjetivos: 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.Item 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 GroupCis 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.Item Estudio sobre actitudes, barreras y prácticas en relación a la vacunación en residentes de la Argentina. Informe final(Fundación Huésped, 2022-03) Zalazar, Virginia; Caballero, Romina; Radusky, Pablo; Arístegui, InésItem 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, PutuWhile 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.Item 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, OmarBackground: 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.Item 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, HéctorBackground: 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.Item High Willingness to Use HIV Pre-Exposure Prophylaxis Among Transgender Women in Argentina(2016-12-01) Zalazar, Virginia; Arístegui, Inés; Kerr, Thomas; Marshall, Brandon D L; Romero, Marcela; Sued, Omar; Socías, M EugeniaFil: Sued O. Fundación Huésped, Buenos Aires; ArgentinaItem 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; ArgentinaItem Home-based HIV testing: Using different strategies among transgender women in Argentina(2020-03-19) Frola, Claudia; Zalazar, Virginia; Cardozo, Nadir; Vázquez, María L. VázquezBackground 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.Item If I'm at home, I do it at home: Qualitative study on HIV self-testing among transgender women in Argentina(2022) De Luca, Amalia; Zalazar, Virginia; Salusso, Diego; Frontini, Emilia; Fabian, Solange; Fernana Cardozo, Nadir; Cesar, Carina; Cahn, Pedro; Sued, Omar; Aristegui, InesBackground: Evidence among key populations supports acceptability of HIV self-testing (HIVST) due to its privacy and convenience. However, insufficient research has been done among transgender women (TGW), especially in Latin America. Consequently, the aim of this study was to explore the acceptability, perceptions and recommendations for HIVST implementation among TGW in Buenos Aires. Methods: A focus group was conducted in July 2019. Particpants were invited to touch and learn about a displayed HIVST kit. The following main topics were explored: acceptability, reasons for seeking self-testing, preferences for training, distribution, periodicity and recommendations for HIVST implementation. Results: The sample consisted of 12 TGWs; mean age of 26 years (IQR = 22–28); 66% had history of sex-work. The main motivations for seeking HIVST were convenience, privacy, and usage to reduce stigma and discrimination by health-care providers. Recommendations for HIVST were: distribution from primary health centers and trans-sensitive centers; affordable price; assistance by peer health promoters; and the provision of clear written and video instructions. Conclusions: Tailored implementation of HIVST can increase HIV testing rates, early detection, and linkage to HIV-care in this high-prevalence group. This study provided community-driven suggestions to inform and adapt an HIVST feasibility pilot study and future implementation in Argentina.Item Impact of the Gender Identity Law in Argentinean transgender women(2017-04) Aristegui, Ines; Radusky, Pablo; Zalazar, Virginia; Romero, Marcela; Schwartz, Jessica; Sued, OmarIn May 2012, collective efforts led to the enactment of a Gender Identity Law in Argentina. This is a particularly progressive law, based on human rights principles, as it is the first in the world to recognize a person's gender identity without any preconditions. However, studies that evaluate its impact on the transgender community (positive outcomes as well as barriers to implementation) have been scant. Thus, the following study investigated the impact of the implementation of the Argentinean Gender Identity Law on the living conditions, plus it explored stigma and discrimination (S&D) experiences of transgender women. Method: Two focus groups, with 20 transgender women, were conducted. Recordings were transcribed and a thematic analysis of the transcripts was performed according to the following categories: general perceived impact of the Law, work and education, security and civil rights, health services, and perceived differences among regions and provinces. Results: After the Law's enactment, participants mostly perceived positive changes, in general, and in particular domains such as education, health care, work, security, and civil rights. A general empowering effect on the community can be inferred. However, barriers to full implementation were identified, both internal and subjective (age, internalized stigma) and external (lack of trained professionals and public servants, reluctance to implementation in conservative provinces). Discussion: This study provides the first evaluation of the implementation and impact of the Gender Identity Law in Argentina from the point of view of transgender women. The empowering effect and the improvements achieved provide preliminary information on the importance of adopting this type of policy. Additionally, the barriers to be overcome and recommendations for the future are discussed.