Background: Despite advances in HIV prevention, transgender women (transwomen) remain at increased risk for HIV infection. As seen in other key populations, syndemics, defined as synergistic psychosocial comorbidities, may exacerbate this risk. There are few studies describing Syndemics for transwomen in low-and-middle income countries (LMIC). We aimed to assess the prevalence of syndemics and high-risk behavior among transwomen in Rio de Janeiro, Brazil.
Methods: This is a cross-sectional analysis of data collected at the screening visit of PrEParadas, a pre-exposure prophylaxis (PrEP) demonstration trial designed for transwomen. Using standardized and validated questionnaires, participants were screened for a history of substance abuse, binge drinking, depression, sexual compulsive behavior and intimate partner violence. We considered the presence of 2+ aforementioned conditions as syndemics. We compared sexual behavior, substance abuse, history of child abuse and victimization among transwomen with and without evidence of syndemics using Chi-square tests.
Results: Of 165 transwomen surveyed, 135 had valid results and were included in the present analysis. The median age was 30 years (interquartile range 24-26) 25.4% were black, 28.4% completed an elementary school education, and 44% were currently unemployed. The prevalence of syndemics was 46.6%. Transwomen presenting syndemics had statistically significant higher prevalences of tobacco abuse, alcohol abuse, cocaine abuse, sexual and violence victimization, child abuse and suicidal risk, as compared to non-syndemic transwomen (Table 1).There were no statistical differences between groups regarding transactional sex (overall prevalence 73.5%), unprotected anal sex (82.6%), and history of sexually transmitted infections (24.2%).
Conclusions: The prevalence of syndemics was high in Brazilian transwomen. Improvements in targeted interventions for mental health and social vulnerabilities are necessary in this population, Syndemics must be considered when designing PrEP engagement and adherence strategies for transwomen in order to improve and reduce the prevalence of HIV infection.



[Table 1]