Resum

BACKGROUND: Transgender women's (TGW) HIV prevalence is 34% in Argentina. Despite efforts to improve the continuum of care, TGW still are lately diagnosed. Since the enactment of the Gender Identity Law, health services providing hormone therapy (HT) have become the gateway to healthcare and a unique opportunity to access other health services. Our objective was to determine HIV prevalence and to identify predictors of lack of testing among TGW seeking HT at a public hospital in Buenos Aires. METHODS: Data from medical records of TGW consulting for HT between July 2012 and December 2019 was used. As the standard of care, individuals at risk of acquiring HIV, unaware of their HIV status, or with outdated results, were invited to test for HIV. Chi-square and Mann'Whitney U test analyses were conducted to compare groups (known/unknown HIV-status). Multivariable logistic regression was performed to examine for predictors. RESULTS: A total of 411 TGW visited the clinic. At first visit, 38.4% (n=158) have never tested for HIV, 27.7% (n=114) were HIV-positive and 33.8% (n=139) were HIV-negative. At follow up, 75/158 participants with unknown status tested for HIV (3 were HIV-positive). 56.4% of HIV-positive TGW reported a history of sex work. TGW still with unknown-HIV status (n=83) were significantly younger (30.8 vs 23.5 years, p=.001), reported less history of sex work (18.1% vs 38.4%, OR 2.8; IC 95%: 1.5-5.2: p=.001), and were less likely to have used HT (44.6% vs 65.9%, OR 2.4; IC 95%: 1.5-3.9: p=.001). CONCLUSIONS: Young TGW who are not involved in sex work or have never used hormones seem not to perceive themselves at risk or are not adequately reached by HIV testing campaigns. To fill in this gap, health programs should design strategies that target this particular subgroup focusing on prevention, testing, and avoidance of risk behaviors. Also, given the high prevalence of HIV among TGW, comprehensive approaches and stronger liaisons with different services are needed. HT can be an opportunity to improve HIV testing and linkage to care, improving overall transgender health.