HIV Prevention and Care of Transgender Women in an HIV and STI Clinic in the Paris Metropolitan Area

2020 ◽  
Vol 7 (4) ◽  
pp. 585-597
Author(s):  
Bahar Azadi ◽  
Julia Zélie ◽  
Florence Michard ◽  
Yazdan Yazdanpanah
Keyword(s):  
Sex Workers ◽  
Social Inclusion ◽  
Preventive Measures ◽  
Transgender Women ◽  
High Rate ◽  
Hiv Care ◽  
Medical Adherence ◽  
Policy And Practice ◽  
Community Based ◽  
Depth Interviews

Abstract HIV infection burden is globally high among transgender women (TGW) and particularly in TGW migrant sex workers and TGW subpopulations with structural inequalities like racism and classism. In addition to stigma related to transphobia, migrant TGW face multiple forms of discrimination because of intersection with other experiences of stigma related to migration and working as sex workers in the host society. This study explores the experiences of TGW seeking care in an HIV and STI clinic in Paris, to evaluate medical adherence, namely, the degree to which a patient is regularly followed up in care and adequately takes the treatment, and trans individuals' social inclusion in this health institution. We examined the different forms of HIV-associated stigma among TGW. A qualitative study was conducted using semistructural in-depth interviews with TGW receiving HIV care and HIV preventive measures. A description is given of how a community-based participation policy and practice in this clinic integrate an intersectional approach among TGW. This results in a high rate of medical adherence in TGW migrants and could lead to social integration.

A Qualitative Exploration of Family, Work, Community, and Health Service Influences on HIV Treatment Uptake and Adherence Among Female Sex Workers in Three Cities in Indonesia

2020 ◽  
Vol 32 (3) ◽  
pp. 243-259
Author(s):  
Elke Mitchell ◽  
Elan Lazuardi ◽  
Irma Anintya ◽  
Emily Rowe ◽  
Kate Whitford ◽  
...  
Keyword(s):  
Support Groups ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Treatment Initiation ◽  
Geographical Location ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Community Based ◽  
Female Sex ◽  
Outreach Workers

Qualitative data were collected from 34 Indonesian female sex workers to understand their engagement with HIV treatment. Influences that enhanced treatment initiation and adherence included women's desires to stay healthy to continue working to provide for families; awareness of the biomedical benefits of treatment; support from bosses, outreach workers, and peer support groups; and flexible, nonjudgmental HIV service provision. Influences inhibiting treatment initiation and adherence included concerns about unwanted disclosure in the workplace and side effects of medication on women's capacity to earn money through sex work; geographical location of services; discrimination and confidentiality concerns in HIV care services. To improve HIV treatment initiation and adherence among Indonesian female sex workers, future responses should explore health promotion messages that engage with women's family and livelihood obligations; increased funding for community-based peer outreach workers; community-based treatment initiation and supply; and advocacy in work environments to secure support for treatment initiatives.

scholarly journals Perceived Need and Acceptability of a Community-Based Peer Navigator Model to Engage Key Populations in HIV Care in Tijuana, Mexico

2020 ◽  
Vol 19 ◽  
pp. 232595822091927
Author(s):  
Eileen V. Pitpitan ◽  
Maria Luisa Mittal ◽  
Laramie R. Smith
Keyword(s):  
Hiv Care ◽  
Key Populations ◽  
Community Based ◽  
Perceived Need ◽  
Community Stakeholders ◽  
Key Stakeholders ◽  
Community Forum ◽  
Care Outcomes ◽  
Living With Hiv ◽  
Depth Interviews

Introduction: Prior work found <4% of key populations living with HIV (KPLWH) in Tijuana, Mexico, were on antiretroviral therapy (ART). The goal of this pilot study was to examine community stakeholders’ perceived need and acceptability of a peer-navigator program to improve ART coverage. Methods: We held a community forum and measured perspectives of key stakeholders in local organizations that serve KPLWH using online surveys, and in-depth interviews (with select key informants). Results: Univariate descriptive statistics and emergent thematic analysis illustrated that there was general consensus that the program could improve ART coverage for KPLWH by helping to overcome geographic, transportation, and sociostructural barriers to HIV care. Police harassment, mobility, and non-HIV comorbidities were identified as challenges the program would need to navigate. Conclusions: Community stakeholders expressed perceived need and acceptability of a program to improve HIV care outcomes among KPLWH in Tijuana. The program should address the challenges identified by community stakeholders.

scholarly journals Facilitators and Barriers to Linkage to HIV Care among Female Sex Workers Receiving HIV Testing Services at a Community-Based Organization in Periurban Uganda: A Qualitative Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sharon Nakanwagi ◽  
Joseph K. B. Matovu ◽  
Betty N. Kintu ◽  
Frank Kaharuza ◽  
Rhoda K. Wanyenze
Keyword(s):  
Qualitative Study ◽  
Peer Support ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Hiv Care ◽  
Community Based ◽  
Community Based Organization ◽  
Hiv Testing Services ◽  
Facilitators And Barriers ◽  
Linkage To Hiv Care

Introduction. While four in ten female sex workers (FSWs) in sub-Saharan Africa are infected with HIV, only a small proportion is enrolled in HIV care. We explored facilitators and barriers to linkage to HIV care among FSWs receiving HIV testing services at a community-based organization in periurban Uganda. Methods. The cross-sectional qualitative study was conducted among 28 HIV positive FSWs from May to July 2014. Key informant interviews were conducted with five project staff and eleven peer educators. Data were collected on facilitators for and barriers to linkage to HIV care and manually analyzed following a thematic framework approach. Results. Facilitators for linkage to HIV care included the perceived good quality of health services with same-day results and immediate initiation of treatment, community peer support systems, individual’s need to remain healthy, and having alternative sources of income. Linkage barriers included perceived stigma, fear to be seen at outreach HIV clinics, fear and myths about antiretroviral therapy, lack of time to attend clinic, and financial constraints. Conclusion. Linkage to HIV care among FSWs is influenced by good quality friendly services and peer support. HIV service delivery programs for FSWs should focus on enhancing these and dealing with barriers stemming from stigma and misinformation.

scholarly journals 1307. Virologic Failure in HIV-Infected Men Who Have Sex with Men and Transgender Women Treated in a Community-Based Model vs. a Hospital-based Model

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S471-S471
Author(s):  
Maximo O Brito ◽  
Shaveta Khosla ◽  
Supriya D Mehta ◽  
Richard M Novak
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Virologic Failure ◽  
Transgender Women ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hiv Care ◽  
Cumulative Probability ◽  
Community Based ◽  
Sex With Men

Abstract Background Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV, especially those that belong to minority groups and lower socioeconomic status. The purpose of this study was to compare virologic failure in MSM and transgender women receiving HIV care at a community-based model (CBM) to a hospital-based model (HBM) of care. Methods This was a retrospective cohort study. We extracted data from electronic medical records of HIV-infected MSM and transgender women treated at one of the six community clinics or at a hospital-based clinic in Chicago between 2010 to 2014. The outcome was cumulative probability of virologic failure (i.e., viral load ≥200 copies/mL), measured in each semester of observation. We used multivariable Cox Proportional Hazards model to determine the association between CBM and HBM with virologic failure, adjusted for confounding variables. Results The sample consisted of 290 patients; of whom, 20 (7%) were transgender. Approximately half (49%) of the sample received care via CBM. Compared with patients receiving care at the HBM, CBM patients were more likely to be African American (72% vs. 61%), uninsured (50% vs. 39%) and with a history of substance abuse (38% vs. 24%). There was no difference in virologic failure between the two care models (57% in CBM vs. 52% in HBM; HRadj = 1.1; 95% CI: 0.8–1.6). Younger individuals (HRadj = 4.0; 95% CI: 2.3–7.1), alcohol users (HRadj = 1.6; 95% CI: 1.1–2.2) and patients without insurance (HRadj = 1.7; 95% CI: 1.1–2.6) were more likely to have virologic failure. Conclusion The CBM was as effective as a traditional HBM in providing care to MSM and transgender women despite their more marginalized status. Intensive outreach and targeted case management likely contributed to the effectiveness of this model and need further study. Disclosures All authors: No reported disclosures.

scholarly journals Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

2019 ◽  
Author(s):  
Daniel Nyato ◽  
Soori Nnko ◽  
Albert Komba ◽  
Evodius Kuringe ◽  
Marya Plotkin ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
System Level ◽  
Hiv Care ◽  
Care Providers ◽  
Community Based ◽  
Infected Female ◽  
Female Sex ◽  
Linkage To Hiv Care

AbstractBackgroundHIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.MethodsWe conducted 21 focus group discussions (FGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.ResultsInfluences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.ConclusionFindings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

A community-based model of HIV care for men who have sex with men and transgender women in Chicago

2020 ◽  
Vol 31 (2) ◽  
pp. 150-157
Author(s):  
Maximo O Brito ◽  
Shaveta Khosla ◽  
Lyanne Santana ◽  
Antonio Lubrano ◽  
Tamara Martinez ◽  
...  
Keyword(s):  
Illicit Drugs ◽  
Virologic Failure ◽  
Transgender Women ◽  
Hiv Care ◽  
Cumulative Probability ◽  
Hiv Viral Load ◽  
Community Based ◽  
Sex With Men ◽  
Cox Proportional Hazard Regression ◽  
Living With Hiv

Socioeconomically disadvantaged men who have sex with men (MSM) and transgender women (TGW) share a disproportionate burden of the HIV epidemic. Providing care in the community may help improve retention and treatment outcomes of these clients. Our objective was to compare HIV outcomes between a community-based model (CBM) and a hospital-based model (HBM) of HIV care. This was a retrospective cohort study of MSM and TGW with HIV treated at community clinics or at a hospital-based clinic. The primary outcome was the cumulative probability of virologic failure (HIV viral load ≥200 copies/ml). We conducted multivariable Cox proportional hazard regression to identify differences in outcome by care setting. Of 258 MSM and TGW, approximately half received care in the CBM. They were more likely to be African American (71% versus 59%), uninsured (48% versus 39%), and used illicit drugs (40% versus 25%). There was no difference in virologic failure by setting (58% CBM, 53% HBM; cumulative incidence of virologic failure: 35% CBM, 25% HBM; adjusted HR = 1.11; 95% CI: 0.88–1.39). Despite serving clients at greater risk for failure, virologic failure in our CBM was similar to a traditional HBM for MSM and TGW living with HIV.

scholarly journals A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d’Ivoire: the ANRS 12381 PRINCESSE project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Valentine Becquet ◽  
Marcellin Nouaman ◽  
Mélanie Plazy ◽  
Aline Agoua ◽  
Clémence Zébago ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Cote D'ivoire ◽  
Sex Workers ◽  
Côte D’Ivoire ◽  
Community Based ◽  
Cote D’Ivoire ◽  
Côte D'ivoire ◽  
Exposure Prophylaxis ◽  
Depth Interviews

Abstract Background Pre-exposure prophylaxis (PrEP) is recommended by the WHO for HIV prevention among female sex workers (FSWs). A study conducted in 2016–2017 in Côte d’Ivoire showed that if PrEP is acceptable, FSWs also have many uncovered sexual health needs. Based on this evidence, the ANRS 12381 PRINCESSE project was developed in collaboration with a community-based organization. The main objective is to develop, document, and analyze a comprehensive sexual and reproductive healthcare package among FSWs in Côte d’Ivoire. Methods PRINCESSE is an open, single-arm interventional cohort of 500 FSWs in San Pedro (Côte d’Ivoire) and its surroundings. Recruitment started on November 26th, 2019 and is ongoing; the cohort is planned to last at least 30 months. The healthcare package (including HIV, hepatitis B, and sexually transmitted infection management, pregnancy screening, and contraception) is available both at mobile clinics organized for a quarterly follow-up (10 intervention sites, each site being visited every two weeks) and at a fixed clinic. Four waves of data collection were implemented: (i) clinical and safety data; (ii) socio-behavioral questionnaires; (iii) biological data; and (iv) in-depth interviews with female participants. Four additional waves of data collection are scheduled outside the cohort itself: (i) the medical and activity records of Aprosam for the PRINCESSE participants; (ii) the medical records of HIV+ FSW patients not participating in the PRINCESSE cohort, and routinely examined by Aprosam; (iii) in-depth interviews with key informants in the FSW community; and (iv) in-depth interviews with PRINCESSE follow-up actors. Discussion The PRINCESSE project is one of the first interventions offering HIV oral PrEP as part of a more global sexual healthcare package targeting both HIV- and HIV+ women. Second, STIs and viral hepatitis B care were offered to all participants, regardless of their willingness to use PrEP. Another innovation is the implementation of mobile clinics for chronic/quarterly care. In terms of research, PRINCESSE is a comprehensive, interdisciplinary project combining clinical, biological, epidemiological, and social specific objectives and outcomes to document the operational challenges of a multidisease program in real-life conditions. Trial registration The PRINCESSE project was registered on the Clinicaltrial.gov website (NCT03985085) on June 13, 2019.

HIV care continuum among cisgender and transgender women sex workers in Greater Kuala Lumpur, Malaysia

AIDS Care ◽  
2021 ◽  
pp. 1-7
Author(s):  
Yerina S. Ranjit ◽  
Britton A. Gibson ◽  
Frederick L. Altice ◽  
Adeeba Kamarulzaman ◽  
Iskandar Azwa ◽  
...  
Keyword(s):  
Sex Workers ◽  
Transgender Women ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Kuala Lumpur ◽  
Care Continuum
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