From policy to practice: syndemic and intersectional challenges to ART adherence for transgender women under India's post-test and treat policy.

IF 2.3 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-03-06 DOI:10.1080/17441692.2025.2473446

William Lodge, Jatin Chaudary, Shruta Rawat, Madina Agénor, Alpana Dange, Vivek R Anand, Don Operario, Matthew J Mimiaga, Katie B Biello

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Abstract

Transgender women (TGW) in India face one of the highest HIV prevalence rates among key populations in India, yet data on their engagement in the HIV care cascade is limited. This study investigates barriers and supportive factors for adhering to antiretroviral therapy (ART), which is vital for achieving viral suppression, reducing transmission risk to nearly zero (i.e. undetectable = utransmittable; U = U), and enhancing the quality of life for TGW living with HIV. Between July and September 2023, trained community recruiters recruited 30 TGW living with HIV in Mumbai and New Delhi, India. Using intersectionality and syndemic theory as guiding frameworks, we purposively sampled and conducted semi-structured qualitative interviews. The interviews revealed four main themes - two barriers and two supportive factors influencing ART adherence: the impact of poverty on syndemic factors, intersectional stigma and discrimination, empowerment to overcome barriers, and the influence of inclusive government programmes and policies in improving TGW's access to ART. Despite the availability of free ART immediately after diagnosis under India's 'test and treat' policy, economic instability and intersecting stigma hinder adherence. Our findings reveal that holistic interventions focusing on economic support, stigma reduction, and personal and collective empowerment might improve ART adherence among TGW in India.

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从政策到实践：在印度的检测和治疗后政策下，跨性别妇女坚持抗逆转录病毒治疗的学术和交叉挑战。

印度跨性别妇女（TGW）是印度关键人群中艾滋病毒感染率最高的人群之一，但有关她们参与艾滋病毒护理级反应的数据有限。这项研究调查了坚持抗逆转录病毒治疗（ART）的障碍和支持因素，这对于实现病毒抑制至关重要，将传播风险降低到几乎为零(即无法检测=无法传播；U = U)，并提高感染艾滋病毒的TGW的生活质量。在2023年7月至9月期间，训练有素的社区招聘人员在印度孟买和新德里招募了30名感染艾滋病毒的TGW。以交叉性和共情理论为指导框架，我们有目的地抽样并进行了半结构化的定性访谈。访谈揭示了四个主题——影响抗逆转录病毒治疗依从性的两个障碍和两个支持性因素：贫困对疾病因素的影响、交叉的污名和歧视、增强克服障碍的能力，以及包容性政府方案和政策对改善妇女获得抗逆转录病毒治疗的影响。尽管根据印度的“检测和治疗”政策，诊断后可立即获得免费抗逆转录病毒治疗，但经济不稳定和相互交织的耻辱阻碍了坚持治疗。我们的研究结果表明，以经济支持、减少耻辱感以及个人和集体赋权为重点的整体干预措施可能会改善印度TGW的抗逆转录病毒治疗依从性。

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来源期刊

Global Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

3.00%

发文量

120

期刊介绍： Global Public Health is an essential peer-reviewed journal that energetically engages with key public health issues that have come to the fore in the global environment — mounting inequalities between rich and poor; the globalization of trade; new patterns of travel and migration; epidemics of newly-emerging and re-emerging infectious diseases; the HIV/AIDS pandemic; the increase in chronic illnesses; escalating pressure on public health infrastructures around the world; and the growing range and scale of conflict situations, terrorist threats, environmental pressures, natural and human-made disasters.