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DIAGNOSIS OF ACCESS TO SERVICES AND PREVENTION PROGRAMMES AND REPRODUCTIVE HEALTH OF PEOPLE LIVING WITH HIV. INTRODUCTION. Components of "Health, Dignity and Prevention:

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DIAGNOSIS OF ACCESS TO SERVICES AND PREVENTION PROGRAMMES AND REPRODUCTIVE HEALTH OF PEOPLE LIVING WITH HIV

introduction
INTRODUCTION

Components of "Health, Dignity and Prevention:

The study aims to contribute to the acceleration of results through a diagnostic study in the area of ​​access to sexual and reproductive health for people living with HIV and help promote policies and prevention programs and services of Sexual and Reproductive Health targeted to PLWHA and those most at risk of HIV exposure

methodology
METHODOLOGY
  • Cross sectional study qualitative / cuantitative
  • Participatory
  • Integration of results
  • Cross-sectional observational quantitative study with convenience sampling survey, applied to 814 PLWHA (gay, bisexual, heterosexual men, biologic women and trans women) in 8 cities, except where Lima / Callao, other cities were chosen randomly taking official account of the prevalence.
  • Qualitative study with in-depth interviews and focus groups for PLWHA in the 4 population groups in 5 of the 8 cities. 190 people were contacted.
sociodemographic characteristics
SOCIODEMOGRAPHIC CHARACTERISTICS

Trans women 162 (20%)

- Younger Population: mean age 33 years in Lima / Callao vs. 30 years in other cities

- 10% in Lima / Callao has no ID, on the other cities 30% do not have this document

- Majority have incomplete educational levels: 56% in Lima / Callao vs. 52% in other cities

economic and health situation
ECONOMIC AND HEALTH SITUATION

Trans women

- More than 80% are working (in sex work for more than half of participants in Lima / Callao and third. Part in other cities)

- More 3rd party receives less than minimum wage.

- More than 90% in Lima / Callao and 80% in other cities is not affiliated with any health insurance.

- All who are insured (25%) are affiliated to SIS.

experience of sexuality and sexual practices
EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

Importance of antiretroviral treatment

... No, I do not think sexuality should affected, because I believe that by taking this medicine, we are increasing our defenses and we feel better, stronger to leave (...) Or is that not having a positive diagnosis let's stop having sex life, but as long as watching over and caring for the other couple, or couple of occasions (trans woman, Chimbote) ...

experience of sexuality and sexual practices1
EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

Diagnosis and experience of sexuality

- The diagnosis affects sex

LIMA/CALLAO

OTHER CITIES

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

The qualitative study found quantitative findings

In trans women with less traumatic attitude, there are changes in life with different nuances: low frequency of intercourse, but not interrupted.

But ... after I advised, I realized that AIDS is not synonymous with death, but life-changing, because what once was and I do not. In what once was 100% and I do not, I'll do 30 to 40%, now I care ... (Female trans, Tumbes) ...

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

- Fear of being unable to engage in sex

LIMA/CALLAO

OTHER CITIES

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

In relation to trans women, 13% in Lima / Callao and 17% in other cities reported having a steady male partner.

I would do “sinsoneo”.... Because sometimes like that man and I'll find out there is sometimes drunk ... (Female trans Pucallpa) ...

Preventive and sexual practices

The 44.4% of trans women in Lima / Callao believes that the primary responsibility of the PLWA and 37% think it is the responsibility of each person. In the other cities, 52% think it is the responsibility of each and 20% that the responsibility is shared.

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

  • How to prevent HIV transmission (regular partner) [Lima / Callao]
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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

- How to prevent HIV transmission (regular partner) [other cities]

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

- How to prevent HIV transmission (casual) [Lima / Callao]

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EXPERIENCE OF SEXUALITY AND SEXUAL PRACTICES

- How to prevent HIV transmission (casual) [Other Cities]

availability and access to sexual and reproductive health
AVAILABILITY AND ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH

78% of trans women reported having received information on how to avoid re-infection in Lima / Callao vs. 69% in the other cities. Less than third part asked about their sexual orientation in the last 12 months, which has been provided mostly by counseling and to a lesser extent by medical / as or midwives.

availability and access to sexual and reproductive health1
AVAILABILITY AND ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH
  • Information received on their sexual and reproductive health (Lima / Callao)
  • In other cities the figures are quite similar.
availability and access to sexual and reproductive health2
AVAILABILITY AND ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH

…Caring for the person who is with me, I should not be a promiscuous person. Take everything into control, do not make much mess. Very few fun. That's what I have said to me. (Trans woman, Tumbes) ...

availability and access to sexual and reproductive health3
AVAILABILITY AND ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH

Services provided to people

LIMA/CALLAO

OTHER CITIES

availability and access to sexual and reproductive health4
AVAILABILITY AND ACCESS TO SEXUAL AND REPRODUCTIVE HEALTH
  • A trans women have been offered: Information on hormonal treatment and HIV by 9.5% in Lima / Callao vs. 22.2% in other cities; HAART and body feminization by 12.7% in Lima / Callao vs. 24.2% in the other cities and how to prevent HPV in Lima / Callao to 58% vs. 18.2% in the other cities.
  • I said ... "doctor despite what I have I can get silicone ¿? And the doctor said No. And I say, "but I have a family physician who loves me and I want to be like a complete woman." And I could not have said anything. (Trans Women, Tumbes) ...
conclusions
CONCLUSIONS
  • This study reveals this population as the lower level of schooling completed in all geographical areas.
  • This is a population that largely has no health insurance and its main offices are in sex work and hairdressing. Although their incomes are above the income poverty line.
  • The changes experienced by this population in relation to diagnosis differ from the changes in other populations. The most striking difference is that low sexual frequency, but not interrupted at any time. Here we also see words such as "wild life", "promiscuous" with the imperative of achieving a "normal" life, which finds us once again that the speeches, even the people themselves are permeated by the devices of regulation sexuality
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A good percentage, especially outside of Lima and Callao, report having had unprotected sex in the last month, which could indicate us to be less information and less involvement of health services.

  • It is noted that some practices are choosing to cross with their partners who have to do with an undetectable viral load. In this sense, condom use is restricted to potential partners.
  • The "sinsoneo" for example, is usually performed between VVS trans women. This practice is to perform penetration without a condom and avoid ejaculation during intercourse and try to put the condom just before ejaculation, or ejaculation outside (it is thus an emic term that refers to "withdrawal" or withdrawal, described as one of the behaviors seroadaptativos). This practice is done so when the trans woman performs the active role as a liability.
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There is a high consumption of alcohol and drugs prior to sex in this population.

  • A majority no information was offered about the relationship between hormone treatment and antiretroviral use, nor are they also provide information on diseases of the prostate or anal cancer. In relation to the population of trans women we can see is that the information and services on most issues, except what related to treatment, are absent.
  • In the population of trans women can be targeted "treatment as prevention 'can help gain access to treatment of the population of trans women, in order to have a closer involvement with their reality and not just harm reduction
recommendations
RECOMMENDATIONS
  • It is necessary to address this issue and propose alternatives in counseling for people living with HIV.
  • They must find solutions to each of the realities.
  • It reiterates the need to work together SRH and HIV, but with a new fresh approach and updated.
  • It is proposed to begin discussions on new prevention technologies (treatment and prevention) and for reproduction (sperm washing).
  • It is necessary to move towards a comprehensive approach involving health Health Promotion in action.
  • It is necessary to incorporate the rights approach, sexual, reproductive, but also in relation to human right to identity.
  • Permanently to train counselors and peer counselors to be able to guide users about their sexuality and reproductive choices within a framework of respect for human rights.
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Incorporated within the standard of care comprehensive minimum package of services that encompasses beyond HAART is routinely available within the care pathway users and include: Psychological, nutritional counseling, family planning counseling and prevention other diseases.

  • Include in regional budgets of funds related to recruitment of other health professionals: psychologists / as, nutritionists, psychiatrists, counselors, family planning and the sustainability of the peer counselors.
  • Secure resources to improve infrastructure and provide space for hospitals to protect the confidentiality and privacy of users both in counseling as a medical consultation.
  • Strengthen information systems of hospitals including registration systems and case tracking.