Abstract
Transgender women experience dramatic HIV disparities across the globe. In Guatemala, HIV prevalence among transgender women is over 23.0% compared to 0.8% nationally. Understanding and addressing this disparity requires a holistic perspective that recognizes the synergistic role of social and structural factors throughout the life course. In this chapter we analyze qualitative in-depth interviews with eight transgender women in Guatemala City to explore how social and structural factors contribute to heightened HIV vulnerability. Specifically, we aim to identify mechanisms of influence between the syndemics of social exclusion, stigma, discrimination, and violence and HIV vulnerability. Participants described a context in which transgender stigma is a ubiquitous part of their daily lives. One of the most destructive manifestations of this stigma was family exclusion, which led to participants living in extreme poverty, having limited economic opportunities, and relying on sex work. Violence throughout the life course was another critical mechanism through which stigma impacted HIV vulnerability. Violence also enhanced opportunities for HIV risk, in particular unprotected sex with clients and other partners. Responding to the cumulative effect of these synergistic factors will require innovative, multi-level strategies that engage individuals, families and communities at multiple levels.
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References
Baguso, G. N., Gay, C. L., & Lee, K. A. (2016). Medication adherence among transgender women living with HIV. AIDS Care, 28(8), 976–981. doi:10.1080/09540121.2016.1146401.
Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222. doi:10.1016/S1473-3099(12)70315-8.
Barrington, C. (2016). Understanding and addressing human immunodeficiency virus and sexually transmitted disease disparities among transgender persons. Sexually Transmitted Diseases, 43(7), 412–413. doi:10.1097/OLQ.0000000000000485.
Boyce, S., Barrington, C., Bolaños, H., Galindo Arandi, C., & Paz-Bailey, G. (2012). Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City. Culture, Health & Sexuality, 14(3), 313–327. doi:10.1080/13691058.2011.639393\.
Brennan, J., Kuhns, L. M., Johnson, A. K., Belzer, M., Wilson, E. C., & Garofalo, R. (2012). Syndemic theory and HIV-related risk among young transgender women: The role of multiple, co-occurring health problems and social marginalization. American Journal of Public Health, 102(9), 1751–1757. doi:10.2105/AJPH.2011.300433.
Carrasco, M. A., Barrington, C., Kennedy, C., Perez, M., Donastorg, Y., & Kerrigan, D. (2017). ‘We talk, we do not have shame’: Addressing stigma by reconstructing identity through enhancing social cohesion among female sex workers living with HIV in the Dominican Republic. Culture, Health and Sexuality, 19(5), 543–556. doi:10.1080/13691058.2016.1242779.
Centro Nacional de Epidemiología (CNE). (2012). Estimaciones y proyecciones del VIH y VIH avanzado Guatemala. Guatemala: Ministerio de Salud Pública y Asistencia Social de Guatemala. http://infecciosashr.org/wp-content/uploads/2014/02/Estimaciones-y-Proyecciones-Gua2013-Sept.pdf. Accessed 19 May 2017.
Chakrapani, V., Newman, P. A., Shunmugam, M., Logie, C. H., & Samuel, M. (2017). Syndemics of depression, alcohol use, and victimisation, and their association with HIV-related sexual risk among men who have sex with men and transgender women in India. Global Public Health, 12(2), 250–265. doi:10.1080/17441692.2015.1091024.
Chow, J. Y., Konda, K. A., Borquez, A., Caballero, P., Silva-Santisteban, A., Klausner, J. D., & Cáceres, C. F. (2016). Peru’s HIV care continuum among men who have sex with men and transgender women: Opportunities to optimize treatment and prevention. International Journal of STD & AIDS, 27(12), 1039–1048. doi:10.1177/0956462416645727.
García, P. J., Bayer, A., & Cárcamo, C. P. (2014). The changing face of HIV in Latin America and the Caribbean. Current HIV/AIDS Reports, 11(2), 146–157. doi:10.1007/s11904-014-0204-1.
HIVOS. (2012). E studio diagnóstico de stigma y discriminación hacia personas con VIH, hombres que tiene sexo con hombres (HSH) y mujeres trabajadoras sexuales (MTS) Guatemala: RP-HIVOS.
Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222–231. doi:10.1016/j.socscimed.2015.11.010.
Kerrigan, D., Mbwambo, J., Likindikoki, S., Beckham, S., Mwampashi, A., Shembilu, C., Montsios, A., Leddy, A., Davis, W., & Galai, N. (2017). Project Shikamana: Baseline findings from a community empowerment-based combination HIV prevention trial among female sex workers in Iringa, Tanzania. Journal of Acquired Immune Deficiency Syndrome, 74(Suppl 1), S60–S68. doi:10.1097/qai.0000000000001203.
Loewenberg, S. (2009). Hungry in Guatemala. The Atlantic, August issue. https://www.theatlantic.com/magazine/archive/2009/08/hungry-in-guatemala/307675/. Accessed 20 May 2017.
Maxwell, J. A., & Miller, B. (2008). Categorizing and connecting strategies in qualitative data analysis. In S. N. Hesse-Biber & P. Leavy (Eds.), Handbook of emergent methods (pp. 461–477). New York: The Guildford Press.
Melendez, R. M., Exner, T. A., Ehrhardt, A. A., Dodge, B., Remien, R. H., Rotheram-Borus, M. J., Lightfoot, M., & Hong, D. (2006). Health and health care among male-to-female transgender persons who are HIV positive. American Journal of Public Health, 96(6), 1034–1037. doi:10.2105/AJPH.2004.042010.
Merlo, T & Murali, S. (2012). Human rights violations of lesbian, gay, bisexual, and transgender (LGBT) people in Guatemala: A shadow report. (Submitted for consideration at the 104th Session of the Human Rights Committee) New York: United Nations Human Rights Committee. https://www.law.gwu.edu/sites/www.law.gwu.edu/files/downloads/LGBT%20Guatemala%20Joint%20Submission%20%28English%29%20FINAL.pdf. Accessed 20 May 2017.
Miller, W.C. (2016). Contextual factors that contribute to increased risk of HIV among transgender and MSM sex workers and recommendations for service delivery. The University of North Carolina at Chapel Hill, ProQuest Dissertations Publishing. 10119723.
Mizuno, Y., Frazier, E. L., Huang, P., & Skarbinski, J. (2015). Characteristics of transgender women living with HIV receiving medical care in the United States. LGBT Health, 2(3), 228–234. doi:10.1089/lgbt.2014.0099.
Morales-Miranda, S., Álvarez-Rodríguez. B. E., Arambú, N., Aguilar, J., Huamán, B., Figueroa, W., Osuna-Ramírez, I., Mendizábal, R., Rosales-Arroyo, R. P., & Castillo, A.. (2013). Encuesta de Vigilancia de Comportamiento Sexual y Prevalencia del VIH e ITS, en poblaciones vulnerables y poblaciones clave. Guatemala 2013. Universidad del Valle de Guatemala, MSPAS, HIVOS Inc., Publicación UVG. No.27. http://www.mcr-comisca.org/sites/all/modules/ckeditor/ckfinder/userfiles/files/Informe%20ECVC%20Guatemala%202012-2013%209%20dic%2013%20final.pdf. Accessed 24 May 2017.
Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., & Becker, J. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research, 47(1), 12–23. doi:10.1080/00224490903062258.
Operario, D., & Nemoto, T. (2010). HIV in transgender communities: Syndemic dynamics and a need for multicomponent interventions. Journal of Acquired Immune Deficiency Syndromes, 55(Suppl. 2), S91–S93. doi:10.1097/QAI.0b013e3181fbc9ec.
Perez-Brumer, A. G., Reisner, S. L., McLean, S. A., Silva-Santisteban, A., Huerta, L., Mayer, K. H., ... & Lama, J. R.. (2017). Leveraging social capital: Multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru. Journal of the International AIDS Society, 20(1), 20(1), 1–8. doi: 10.7448/IAS.20.1.21462.
Pollock, L., Silva-Santisteban, A., Sevelius, J., & Salazar, X. (2016). ‘You should build yourself up as a whole product’: Transgender female identity in Lima, Peru. Global Public Health, 11(7–8), 981–993. doi:10.1080/17441692.2016.1167932.
Poteat, T., Scheim, A., Xavier, J., Reisner, S., & Baral, S. (2016). Global epidemiology of HIV infection and related syndemics affecting transgender people. Journal of Acquired Immune Deficiency Syndromes, 72(Suppl. 3), S210–S219. doi:10.1097/QAI.0000000000001087.
Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., Holland, C. E., Max, R., & Baral, S. D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388(10042), 412–436. doi:10.1016/S0140-6736(16)00684-X.
Singer, M. (2010). Pathogen-pathogen interaction: A syndemic model of complex biosocial processes in disease. Virulence, 1(1), 10–18. doi:10.4161/viru.1.1.9933.
Tsai, A. C., & Burns, B. F. (2015). Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept. Social Science & Medicine, 139, 26–35. doi:10.1016/j.socscimed.2015.06.024.
Tsai, A. C., & Venkataramani, A. S. (2016). Syndemics and health disparities: A methodological note. AIDS and Behavior, 20(2), 423–430. doi:10.1007/s10461-015-1260-2.
Tucker, C., Galindo Arandi, C., Herbert Bolaño, J., Paz Bailey, G., & Barrington, C. (2014). Social networks and HIV prevention among men who have sex with men and transgender persons in Guatemala City. Journal of Health Care for the Poor and Underserved, 25(4), 1698–1717. doi:10.1353/hpu.2014.0163.
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Barrington, C., Galindo Arandi, C., Aguilar-Martínez, J.M., Miller, W.M. (2018). Understanding HIV Disparities Among Transgender Women in Guatemala: Linking Social and Structural Factors to HIV Vulnerability. In: Kerrigan, D., Barrington, C. (eds) Structural Dynamics of HIV. Social Aspects of HIV, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-63522-4_1
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