Lauren E. Parmley, Sophia S. Miller, Innocent Chingombe, Munyaradzi Mapingure, Owen Mugurungi, John H. Rogers, Godfrey Musuka, Chesterfield Samba, Avi J. Hakim, Tiffany G. Harris
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Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20–26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all <i>p</i>-value <0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. 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引用次数: 0
摘要
导言 我们试图描述津巴布韦变性女性(TGW)易感染艾滋病的社会和结构性驱动因素,并探索女性表现形式在易感染性方面的差异。 调查对象包括来自津巴布韦两个城市的男男性行为者、变性女性和出生时被指定为男性的性别独特者。调查问卷收集了与社会人口统计学、性行为和药物使用行为以及获得艾滋病服务的社会和结构性障碍相关的信息。二次分析仅限于确认为女性、变性女性或跨性别女性的参与者(236/1538),且未加权。使用描述性统计来计算样本估计值,使用卡方检验和费雪精确检验来评估不同女性易感性的差异。 结果 在 236 名 TGW 中,近一半(45.3%)在调查前 6 个月内表现为女性,8.5% 曾使用荷尔蒙来确认自己的性别认同。女性同性恋者的年龄中位数为 23 岁(四分位数间距:20-26)。在我们的样本中,表现为女性的 TGW 被逮捕(15.9% 对 3.9%)、被家人/朋友排斥(38.3% 对 14.0%)、被解雇(11.2% 对 3.9%)、被拒绝就业(14.0% 对 3.9%)、被拒绝接受医疗服务(16.8% 对 2.3%)、被殴打、性侵犯或性虐待的发生率较高。3%)、身体、性或语言骚扰或虐待(59.8% vs. 34.1%)、酒精依赖(32.7% vs. 12.4%)、最近与男性或 TGW 伴侣发生性交易(30.8% vs. 13.3%)以及最近使用非注射毒品(38.3% vs. 20.2%)(所有 p 值均为 0.05)。 结论 研究结果表明,TGW,尤其是表现为女性的 TGW,经历了社会和结构性的不平等,这可能会导致其易感染艾滋病毒。旨在解决不平等问题的干预措施,包括对服务提供者进行变性能力培训,以及为 TGW 提供性别肯定、社会心理和法律支持服务,可能会降低风险。
Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe
Introduction
We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation.
Methods
A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation.
Results
Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20–26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05).
Conclusions
Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.
期刊介绍:
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.