Objective: To analyze factors associated with detectable HIV viremia among transgender women/transvestites (TWT) in five Brazilian capitals.
Methods: : This was a cross-sectional study using data from a sample of TWT with HIV-positive serology and detectable viral load (VL), between 2019 and 2021. The dependent and independent variables were, respectively: viral load measurement, socioeconomic/demographic characteristics; alcohol/drug use; and self-perceived mental health. Poisson regression with robust variance was used.
Results: : A total of 425 TWT tested positive for HIV and underwent VL measurement, 179 (42.0%) presented detectable viremia. Factors positively associated with detectability were: younger age (PR=2.26; 95%CI 1.13;4.51), poorer housing conditions (PR=2.72; 95%CI 1.30;5.68) and poor/very poor mental health (PR=1.70; 95%CI 1.08;2.66). The use of antiretroviral drugs was a protective factor against detectability (PR=0.29; 95%CI 0.30;0.61).
Conclusion: The factors associated with unsuppressed viral load highlight vulnerability related to gender identity that have a negative impact, despite the majority of participants being on antiretroviral therapy (ART).
Main results: People aged 20-29 who were homeless or unstable and those who reported poor or very poor mental health were more likely to have a detectable viral load. ARV drug use was a protective factor.
Implications for services: The identification of predictors for detectable viral load enables the design of appropriate strategies for monitoring and linking vulnerable people to health services, ensuring effective implementation.
Perspectives: It is necessary to develop educational strategies that take into account important social issues to improve awareness about undetectable viral load in HIV prevention among the transgender population, especially among younger people.
Objetivo: Analizar factores asociados a la viremia detectable del VIH entre mujeres transexuales/travestis (MTTr), en cinco capitales brasileñas.
Métodos: Datos referentes al muestreo MTTr con serología reactiva para VIH y carga viral detectable (CV), en estudio transversal entre 2019-2021. Las variables dependientes e independientes fueron, respectivamente: medición de carga viral, socioeconómicas/demográficas; consumo de alcohol/drogas; y autopercepción de salud mental. Se utilizó la regresión de Poisson con varianza robusta.
Resultados: Un total de 425 MTTr dieron positivo para el VIH y se sometieron a pruebas CV, siendo 179 (42,0%) detectables. Los factores asociados positivamente con la detectabilidad fueron: ser más joven (RP=2,26; IC95% 1,13;4,51), peores condiciones de vivienda (RP=2,72; IC95% 1,30;5,68) y salud mental mala/muy mala (RP=1,70; IC95% 1,08;2,66). El uso de medicamentos antirretrovirales fue un factor protector para la detectabilidad (RP=0,29; IC95% 0,30;0,61).
Conclusión: Los factores asociados a la no supresión viral indican vulnerabilidad ligada a identidad de género con efecto negativo, incluso cuando la mayoría utiliza terapia antirretroviral (TARV).