Omar Sued

Transgender women (TGW) face a high prevalence of HIV, globally. Even in countries with universal access to care, this disparity persists. This population had high substance abuse, housing problems, and many other factors that increase discrimination and limit access to healthcare. Domiciliary interventions could potentially surpass some of the barriers.

The presence of “syndemics” (2 or more of substance abuse, binge drinking, depression, sexual compulsive behavior and intimate partner violence) was 46.6% and associated with child abuse and suicidality. In the TransAmigas project, from 113 HIV+ ¾ were retained and 2/3 taking ARVs. Young TGW had higher ARVs use. In the Divas study, 45% of TGW had regular consumption of alcohol and this was associated to other psychosocial vulnerabilities and high HIV prevalence. In Argentina, domiciliary HIV/Syphilis testing showed high acceptability (98%). Participants preferred simultaneous HIV and syphilis testing (60.3%), think this rapid test is safe and reliable (77.9%) and would repeat (95.6%) and would recommend it. In Malawi, among 117 TG people (40% TG men) most were tested but majority avoided healthcare for discrimination, had significant rates of sexual abuse and mental health problems (23% suicidal ideation).

All presentations revealed high social vulnerability, risks and hazardous use of substance in this population, as well as significant difficulties in accessing care, and in achieving the HIV continuum. The presence of sexual-based violence and mental health problems is also high. In order to enhance HIV prevention and treatment, there is need for the creation of transgender safe spaces in all the countries, reducing stigma and discrimination, in particular in the healthcare setting, and to introduce specific interventions to reduce alcohol and drug use. Domiciliary integrated testing and care could represent a promising strategy to reach individuals and initiate treatment.