<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE root>
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="1.1d1" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher">Bulletin of Semashko National Research Institute of Public Health</journal-id><journal-title-group><journal-title>Bulletin of Semashko National Research Institute of Public Health</journal-title></journal-title-group><issn publication-format="print">2415-8410</issn><issn publication-format="electronic">2415-8429</issn><publisher><publisher-name>FSSBI «N.A. Semashko National Research Institute of Public Health»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">2492</article-id><article-categories><subj-group subj-group-type="heading"><subject>Научная статья</subject></subj-group></article-categories><title-group><article-title>Social barriers and facilitators in access to HIV testing, prevention and treatment for transgender women: a scoping review</article-title></title-group><contrib-group><contrib contrib-type="author"><name name-style="western"><surname>Kirey-Sitnikova</surname><given-names>Yana</given-names></name><bio></bio><email>yana.kirey.sitnikova@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff id="aff-1">Eurasian Coalition on Health, Rights, Gender and Sexual Diversity</aff><pub-date date-type="epub" iso-8601-date="2022-12-15" publication-format="electronic"><day>15</day><month>12</month><year>2022</year></pub-date><issue>4</issue><fpage>57</fpage><lpage>64</lpage><history><pub-date date-type="received" iso-8601-date="2022-11-25"><day>25</day><month>11</month><year>2022</year></pub-date></history><permissions><copyright-statement>Copyright © 2022,</copyright-statement><copyright-year>2022</copyright-year></permissions><abstract>Transgender women (TGW) are individuals who were assigned male at birth but identify as women. TGW are at high risk of being infected with HIV and face severe barriers in access to HIV-related medical care, including testing, prevention and treatment. The present review aims to summarize the data on social barriers to HIV services for TGW published in English-language literature. Systematic search in Web of Science, Scopus and PubMed was used to identify 53 articles available for analysis. The main barriers include: lack of or insufficient knowledge on HIV issues; stigma; suboptimal organization of medical care; lack of awareness and sensitivity on behalf of medical specialists; barriers related to gender identity; financial barriers; lack of support on behalf of the family and close ones; intersectional discrimination. Raising awareness of medical professionals on trans issues, integration of HIV-related services and transgender healthcare, as well as increasing the diversity of methods of testing and prevention are among the approaches to improving the access to HIV-related care.</abstract><kwd-group xml:lang="en"><kwd>transgender</kwd><kwd>transsexual</kwd><kwd>gender dysphoria</kwd><kwd>gender incongruence</kwd><kwd>access to healthcare</kwd><kwd>HIV</kwd><kwd>review</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>трансгендерность</kwd><kwd>транссексуальность</kwd><kwd>гендерная дисфория</kwd><kwd>гендерное несоответствие</kwd><kwd>доступ к медицинской помощи</kwd><kwd>ВИЧ</kwd><kwd>обзор</kwd></kwd-group></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214-22.</mixed-citation></ref><ref id="B2"><label>2.</label><mixed-citation>Leite BO, Medeiros DS, Magno L, Bastos FI, Coutinho C, Brito AM, et al. Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil.Int J Equity Health. 2021 Dec;20(1):1-1.</mixed-citation></ref><ref id="B3"><label>3.</label><mixed-citation>Restar AJ, Adia A, Cu-Uvin S, Operario D. Characterizing PrEP awareness and interest among Filipina transgender women. AIDS Educ Prev. 2020 Jun;32(3):212-28.</mixed-citation></ref><ref id="B4"><label>4.</label><mixed-citation>Galka JM, Wang M, Azwa I, Gibson B, Lim SH, Shrestha R, et al. Willingness to Use Pre-Exposure Prophylaxis (PrEP) for HIV Prevention and PrEP Implementation Preferences Among Transgender Women in Malaysia. Transgender Health. 2020 Dec 1;5(4):258-66.</mixed-citation></ref><ref id="B5"><label>5.</label><mixed-citation>Jin H, Restar A, Biello K, Kuhns L, Reisner S, Garofalo R, et al. Burden of HIV among young transgender women: factors associated with HIV infection and HIV treatment engagement. AIDS Care. 2019 Jan 2;31(1):125-30.</mixed-citation></ref><ref id="B6"><label>6.</label><mixed-citation>Jalil EM, Torres TS, Luz PM, Monteiro L, Moreira RI, Castro CR, et al. Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study. J Int AIDS Soc. 2022 Mar;25(3):e25896.</mixed-citation></ref><ref id="B7"><label>7.</label><mixed-citation>Baguso GN, Turner CM, Santos GM, Raymond HF, Dawson-Rose C, Lin J, et al. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc. 2019 Apr;22(4):e25270.</mixed-citation></ref><ref id="B8"><label>8.</label><mixed-citation>Chakrapani V, Shaikh S, Arumugam V, Chawla U, Mehta S. Factors Influencing Willingness to Use Human Immunodeficiency Virus Preexposure Prophylaxis Among Transgender Women in India. Transgender Health. 2021 Apr 1;6(2):64-73.</mixed-citation></ref><ref id="B9"><label>9.</label><mixed-citation>Lacombe-Duncan A, Bauer GR, Logie CH, Newman PA, Shokoohi M, Kay ES, et al. The HIV care cascade among transgender women with HIV in Canada: a mixed-methods study. AIDS Patient Care STDs. 2019 Jul 1;33(7):308-22.</mixed-citation></ref><ref id="B10"><label>10.</label><mixed-citation>Bukowski LA, Chandler CJ, Creasy SL, Matthews DD, Friedman MR, Stall RD. Characterizing the HIV care continuum and identifying barriers and facilitators to HIV diagnosis and viral suppression among black transgender women in the United States. J Acquir Immune Defic Syndr. 2018 Dec 1;79(4):413-420.</mixed-citation></ref><ref id="B11"><label>11.</label><mixed-citation>Hotton AL, Perloff J, Paul J, Parker C, Ducheny K, Holloway T, et al. Patterns of exposure to socio-structural stressors and HIV care engagement among transgender women of color. AIDS and Behavior. 2020 Nov;24(11):3155-63.</mixed-citation></ref><ref id="B12"><label>12.</label><mixed-citation>Wilson EC, Turner C, Arayasirikul S, Woods T, Nguyen T, Lin R, et al. Housing and income effects on HIV-related health outcomes in the San Francisco Bay Area-findings from the SPNS transwomen of color initiative. AIDS care. 2018 Nov 2;30(11):1356-9.</mixed-citation></ref><ref id="B13"><label>13.</label><mixed-citation>Koblin BA, Usher D, Nandi V, Tieu HV, Bravo E, Lucy D, et al. Post-exposure prophylaxis awareness, knowledge, access and use among three populations in New York City, 2016-17. AIDS Behav. 2018 Aug;22(8):2718-32.</mixed-citation></ref><ref id="B14"><label>14.</label><mixed-citation>Poteat T, Malik M, Merwe LL, Cloete A, Adams D, Nonyane BA, et al. PrEP awareness and engagement among transgender women in South Africa: a cross-sectional, mixed methods study. Lancet HIV. 2020 Dec 1;7(12):e825-34.</mixed-citation></ref><ref id="B15"><label>15.</label><mixed-citation>D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, et al. Medical mistrust and PrEP perceptions among transgender women: a cluster analysis. Behav Med. 2019 Apr 3;45(2):143-52.</mixed-citation></ref><ref id="B16"><label>16.</label><mixed-citation>Restar AJ, Kuhns L, Reisner SL, Ogunbajo A, Garofalo R, Mimiaga MJ. Acceptability of antiretroviral pre-exposure prophylaxis from a cohort of sexually experienced young transgender women in two US cities. AIDS Behav. 2018; 22(11):3649-57.</mixed-citation></ref><ref id="B17"><label>17.</label><mixed-citation>Soares F, MacCarthy S, Magno L, Silva LA, Amorim L, Nunn A, et al. Factors associated with PrEP refusal among transgender women in Northeastern Brazil. AIDS Behav. 2019 Oct;23(10):2710-8.</mixed-citation></ref><ref id="B18"><label>18.</label><mixed-citation>Ingram MV, Amodei N, Perez VV, German V. Factors predicting 12-month retention in care for minority women living with HIV. Therapeutic Advances in Infectious Disease. 2022 Apr;9:20499361221089815.</mixed-citation></ref><ref id="B19"><label>19.</label><mixed-citation>Reback CJ, Rünger D, Fletcher JB. Drug use is associated with delayed advancement along the HIV care continuum among transgender women of color. AIDS Behav. 2021 Jul;25(1):107-15.</mixed-citation></ref><ref id="B20"><label>20.</label><mixed-citation>Rosen JG, Malik M, Cooney EE, Wirtz AL, Yamanis T, Lujan M, et al. Antiretroviral treatment interruptions among Black and Latina transgender women living with HIV: characterizing co-occurring, multilevel factors using the gender affirmation framework. AIDS Behav. 2019 Sep;23(9):2588-99.</mixed-citation></ref><ref id="B21"><label>21.</label><mixed-citation>Yi S, Sok S, Chhim S, Chhoun P, Chann N, Tuot S, et al. Access to community-based HIV services among transgender women in Cambodia: findings from a national survey.Int J Equity Health. 2019 Dec;18(1):1-3.</mixed-citation></ref><ref id="B22"><label>22.</label><mixed-citation>Cahill SR, Keatley J, Wade TS, Sevelius J, Elsesser SA, Geffen SR, et al. “Some of us, we don’t know where we’re going to be tomorrow.” Contextual factors affecting PrEP use and adherence among a diverse sample of transgender women in San Francisco. AIDS care. 2020 May 3;32(5):585-93.</mixed-citation></ref><ref id="B23"><label>23.</label><mixed-citation>Chakrapani V, Shunmugam M, Rawat S, Baruah D, Nelson R, Newman PA. Acceptability of HIV pre-exposure prophylaxis among transgender women in India: a qualitative investigation. AIDS Patient Care STDs. 2020 Feb 1;34(2):92-8.</mixed-citation></ref><ref id="B24"><label>24.</label><mixed-citation>Pal K, Ngin C, Tuot S, Chhoun P, Ly C, Chhim S, Luong MA, et al. Acceptability study on HIV self-testing among transgender women, men who have sex with men, and female entertainment workers in Cambodia: a qualitative analysis. PLoS One. 2016 Nov 9;11(11):e0166129.</mixed-citation></ref><ref id="B25"><label>25.</label><mixed-citation>Bockting W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and retention in HIV care for transgender women: perspectives of medical and social service providers in New York City. AIDS Patient Care STDs. 2020 Jan 1;34(1):16-26.</mixed-citation></ref><ref id="B26"><label>26.</label><mixed-citation>Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, et al. Multilevel barriers to HIV PrEP uptake and adherence among black and Hispanic/Latinx transgender women in southern California. AIDS Behav. 2021 Jul;25(7):2301-15.</mixed-citation></ref><ref id="B27"><label>27.</label><mixed-citation>Rael CT, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W, et al. Barriers and facilitators to oral PrEP use among transgender women in New York City. AIDS Behav. 2018;22(11):3627-36.</mixed-citation></ref><ref id="B28"><label>28.</label><mixed-citation>Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5-16.</mixed-citation></ref><ref id="B29"><label>29.</label><mixed-citation>Sevelius JM, Keatley J, Calma N, Arnold E. I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7-8):1060-75.</mixed-citation></ref><ref id="B30"><label>30.</label><mixed-citation>Bass SB, Kelly PJ, Brajuha J, Gutierrez-Mock L, Koester K, D’Avanzo P, et al. Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication. BMC Public Health. 2022 Dec;22(1):1-0.</mixed-citation></ref><ref id="B31"><label>31.</label><mixed-citation>Longino A, Montano MA, Sanchez H, Bayer A, Sanchez J, Tossas-Milligan K, et al. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Perú: what and whom do different patients trust? AIDS Care. 2020 Feb 1;32(2):255-60.</mixed-citation></ref><ref id="B32"><label>32.</label><mixed-citation>Poteat T, Wirtz A, Malik M, Cooney E, Cannon C, Hardy WD, et al. A gap between willingness and uptake: findings from mixed methods research on HIV prevention among black and Latina transgender women. J Acquir Immune Defic Syndr. 2019 Oct 1;82(2):131-140.</mixed-citation></ref><ref id="B33"><label>33.</label><mixed-citation>Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India. AIDS Care. 2011 Dec 1;23(12):1687-94.</mixed-citation></ref><ref id="B34"><label>34.</label><mixed-citation>Hines DD, Draucker CB, Habermann B. HIV testing and entry to care among trans women in Indiana. J Assoc Nurses AIDS Care. 2017 Sep 1;28(5):723-36.</mixed-citation></ref><ref id="B35"><label>35.</label><mixed-citation>Mitchell E, Lazuardi E, Rowe E, Anintya I, Wirawan DN, Wisaksana R, et al. Barriers and enablers to HIV care among Waria (transgender women) in Indonesia: a qualitative study. AIDS Education and Prevention. 2019 Dec;31(6):538-52.</mixed-citation></ref><ref id="B36"><label>36.</label><mixed-citation>Sevelius J, Murray LR, Martinez Fernandes N, Veras MA, Grinsztejn B, Lippman SA. Optimising HIV programming for transgender women in Brazil. Cult Health Sex. 2019 May 4;21(5):543-58.</mixed-citation></ref><ref id="B37"><label>37.</label><mixed-citation>Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, et al.Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care. 2022;13:1-9.</mixed-citation></ref><ref id="B38"><label>38.</label><mixed-citation>Wilson EC, Jalil EM, Castro C, Martinez Fernandez N, Kamel L, Grinsztejn B. Barriers and facilitators to PrEP for transwomen in Brazil. Glob Public Health. 2019 Feb 1;14(2):300-8.</mixed-citation></ref><ref id="B39"><label>39.</label><mixed-citation>Logie CH, James L, Tharao W, Loutfy MR. We don’t exist”: a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada. J Int AIDS Soc. 2012 Apr;15(2):10-7448.</mixed-citation></ref><ref id="B40"><label>40.</label><mixed-citation>Monteiro S, Brigeiro M. Experiences of transgender women/transvestites with access to health services: progress, limits, and tensions. Cad Saude Publica. 2019 Apr 8;35(4):e00111318.</mixed-citation></ref><ref id="B41"><label>41.</label><mixed-citation>Ssekamatte T, Isunju JB, Naume M, Buregyeya E, Mugambe RK, Wanyenze RK, et al. Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda. BMC Infect Dis. 2020 Dec;20(1):1-5.</mixed-citation></ref><ref id="B42"><label>42.</label><mixed-citation>Lacombe-Duncan A, Kia H, Logie CH, Todd KP, Persad Y, Leblanc G, et al. A qualitative exploration of barriers to HIV prevention, treatment and support: perspectives of transgender women and service providers. Health Soc Care Community. 2021 Sep;29(5):e33-46.</mixed-citation></ref><ref id="B43"><label>43.</label><mixed-citation>Munro L, Marshall Z, Bauer G, Hammond R, Nault C, Travers R. (Dis) integrated care: barriers to health care utilization for trans women living with HIV. J Assoc Nurses AIDS Care. 2017 Sep 1;28(5):708-22.</mixed-citation></ref><ref id="B44"><label>44.</label><mixed-citation>Nieto O, Fehrenbacher AE, Cabral A, Landrian A, Brooks RA. Barriers and motivators to pre-exposure prophylaxis uptake among Black and Latina transgender women in Los Angeles: perspectives of current PrEP users. AIDS Care. 2021 Feb 1;33(2):244-52.</mixed-citation></ref><ref id="B45"><label>45.</label><mixed-citation>Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, et al. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc. 2022 Jul;25:e25933.</mixed-citation></ref><ref id="B46"><label>46.</label><mixed-citation>Restar AJ, Santamaria EK, Adia A, Nazareno J, Chan R, Lurie M, et al. Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women. Plos One. 2019 Oct 21;14(10):e0224133.</mixed-citation></ref><ref id="B47"><label>47.</label><mixed-citation>Dowshen N, Lee SS, Castillo M, Hawkins L, Barg FK. Barriers and facilitators to HIV prevention, testing, and treatment among young transgender women. J Adolesc Health. 2016 Feb 1;58(2):S81-2.</mixed-citation></ref><ref id="B48"><label>48.</label><mixed-citation>Melendez RM, Pinto RM. HIV prevention and primary care for transgender women in a community-based clinic. J Assoc Nurses AIDS Care. 2009 Sep 1;20(5):387-97.</mixed-citation></ref><ref id="B49"><label>49.</label><mixed-citation>Lippman SA, Moran L, Sevelius J, Castillo LS, Ventura A, Treves-Kagan S, et al. Acceptability and feasibility of HIV self-testing among transgender women in San Francisco: a mixed methods pilot study. AIDS Behav. 2016 Apr;20(4):928-38.</mixed-citation></ref><ref id="B50"><label>50.</label><mixed-citation>Wood SM, Lee S, Barg FK, Castillo M, Dowshen N. Young transgender women’s attitudes toward HIV pre-exposure prophylaxis. J Adolesc Health. 2017 May;1;60(5):549-55.</mixed-citation></ref><ref id="B51"><label>51.</label><mixed-citation>Storholm ED, Ogunbajo A, Nacht CL, Opalo C, Horvath K, Lyman P, et al. Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California. Behav Med. 2022;23:1-2.</mixed-citation></ref><ref id="B52"><label>52.</label><mixed-citation>Everhart AR, Boska H, Sinai-Glazer H, Wilson-Yang JQ, Burke NB, LeBlanc G, et al. I’m not interested in research; i’m interested in services’: How to better health and social services for transgender women living with and affected by HIV. Soc Sci Med. 2022;292:114610.</mixed-citation></ref><ref id="B53"><label>53.</label><mixed-citation>Wirtz AL, Clouse E, Veronese V, Thu KH, Naing S, Baral SD, et al. New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self-testing among men who have sex with men and transgender women in Yangon, Myanmar. J Int AIDS Soc. 2017;20(1):21796.</mixed-citation></ref><ref id="B54"><label>54.</label><mixed-citation>Rael CT, Lopez-Ríos J, McKenna SA, Das D, Dolezal C, Abascal E, et al. Transgender Women’s barriers, facilitators, and preferences on tailored injection delivery strategies to administer long-acting injectable cabotegravir (CAB-LA) for HIV pre-exposure prophylaxis (PrEP). AIDS Behav. 2021;Dec;25(12):4180-92.</mixed-citation></ref></ref-list></back></article>
