Saúde mental e sindemia entre TRANS avaliadas para o uso de profilaxia pré-exposição ao HIV

Background: Transgender women (TGW) remain at increased risk for HIV infection. Syndemics (i.e., synergistic psychosocial comorbidities) may exacerbate this risk and is understudied among transwomen in low-and-middle income countries (LMIC). We assessed the prevalence of syndemics, mental health problems and risk behavior for HIV, as well as factors associated with syndemics among TGW evaluated for preexposure prophylaxis (PrEP) from Rio de Janeiro, Brazil. Methods: Cross-sectional analysis of data collected at the screening visit of PrEParadas study, a PrEP TGWspecific demonstration trial. Participants (\226518 years) were screened for polysubstance use, binge drinking, depression, sexual compulsive behavior (SCB), and intimate partner violence (IPV). The presence of \22652 conditions was considered syndemics. Bivariate analysis and stepwise backwards logistic regression were performed to evaluate the association of demographics, mental health problems, risk behavior for HIV, social problems, violence and gender discrimination with syndemics Results: The sample comprised 143 TGW with median age of 30 years, 73.4% were non-white, 72.7% completed \22658 years of education and 53.8% were currently unemployed. Regarding mental health, 31.5% screened positive for anxiety, 23.8% high impulsivity and 16.1% for suicide risk. Condomless receptive anal sex in the previous 6 months was reported by 81.1% and 74.1% reported lifetime transactional sex. The prevalence of syndemics was 44.8%. In the logistic regression model, factors associated with syndemics were being non-white (adjusted Odds Ratio - AOR 5.3, 95% CI: 1.7 - 16.1), illicit drug abuse/dependence (AOR 3.1 , 95% CI 1.2 - 8.3), presenting anxiety (AOR 3.2, 95% CI 1.1 - 9.5), high impulsivity (AOR 3.8, 95% CI: 1.2 - 11.5) and having suffered sexual/physical violence (AOR 5.4, 95% CI: 2.1 - 13.7). Conclusion: The prevalence of syndemics was high among the TRANS assessed for PrEP in Rio de Janeiro. Screening syndemic and mental health problems among this highly vulnerable population is an important step to improve transwomen health. PrEP services may be an important gate to link they into appropriate treatment. Future tailored research and interventions addressing the mental health, including PTSD, are crucial to improve the health of this population.