Vulnerabilidades ao hiv e à sífilis ativa entre mulheres trans e travestis com diferentes perfis sociodemográficos

Abstract

Introduction: Transsexuality is historically marked by trajectories of struggle, marginalization, and social invisibility, factors that contribute to the intensification of vulnerability to STIs. It is estimated that trans women and transvestites have up to twenty times greater risk of acquiring HIV and active syphilis compared to the general population. Despite the seriousness of this scenario, most studies focused on this population do not contemplate the analysis of vulnerability from an intersectional perspective, neglecting the combined effects of factors such as gender, race, class, territory, and access to health. This gap highlights the unprecedented nature of the present research, which seeks to understand the vulnerability profiles of transgender women and transvestites from an intersectional approach, contributing to the production of critical and contextualized knowledge in the field of public health. Objective: To investigate, from an intersectional perspective, the vulnerability factors associated with the prevalence of HIV and active syphilis among transgender women and transvestites in a municipality in the interior of Goiás, Central, Brazil. Method: This is an observational, cross-sectional, and analytical study, conducted with 32 participants recruited using the snowball sampling method. Participants answered a structured questionnaire about sociodemographic, behavioral, and health service access conditions, in addition to undergoing rapid HIV and syphilis testing. Analyses included descriptive statistics, Fisher's exact test, two-step cluster analysis, and binary logistic regression. Results: The sample was predominantly composed of transgender women (93.8%), of mixed race/black (78.1%), aged 25 to 34 years (43.8%), heterosexual (65.6%), with 12 or more years of schooling (59.4%), and users of the Brazilian Unified Health System (SUS) (87.5%). The sociodemographic, behavioral, and health access variables analyzed did not show a statistically significant influence on the investigated outcomes (P>0.005). Cluster analysis identified two distinct groups: Profile A, composed mainly of transgender women aged 25 to 34 years, black, and residing in peripheral neighborhoods; and Profile B, formed by transgender women aged 18 to 24 years, black, and residing in central neighborhoods. The prevalence of syphilis and HIV was higher in Profile A (36.8% and 21.1%) compared to Profile B (15.4% and 23.1%), with no statistical difference (p = 0.249 and p = 1.000). In the logistic regression, no significant associations were observed between the profiles and diagnoses of HIV (OR = 1.125; 95% CI: 0.206–6.142; p = 0.892) or syphilis (OR = 0.312; 95% CI: 0.053–1.833; p = 0.197). Conclusion: The results indicate that, even in the face of distinct social conditions, vulnerability to STIs remains widespread and shared among the trans women and transvestites studied.