(P162) Disparities in HPV vaccination among trans women in Brazil

Tuesday, July 25, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Maria C. Carvalho (she/her/hers)

Medical Student
Faculdade de Ciências Médicas Santa Casa de São Paulo
São Paulo, Sao Paulo, Brazil

Co-author(s)

CM

Cristina K. Martins

CRT DST/ AIDS Centro de Referência e Treinamento em DST AIDS SES SP, United States
Katia C. Bassichetto, PhD

Researcher
NUDHES/Faculdade de Ciências Médicas Santa Casa de São Paulo, Brazil
EW

ELIANA MARCIA DA ROS WENDLAND, PhD

Hospital Moinhos de Vento and Federal University of Health Science of Porto Alegre
Porto Alegre, Brazil
AL

Andrea Leal

Departamento de Sociologia, Instituto de Filosofia e Ciências Humanas, da UFRGS, United States
luis fernando gomes carreira

MD
Faculdade de Ciências Médicas da Santa Casa de São Paulo, FCMSCSP, Brasil
Sao Paulo, Brazil
PM

Philippe Mayaud

Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine
London, England, United Kingdom
BS

Bow Suprasert

San Francisco Department of Public Health, United States
EW

Erin Wilson

San Francisco Department of Public Health, United States
WM

Willi McFarland

San Francisco Department of Public Health, United States
MV

Maria Veras

Faculdade de Ciências Médicas da Santa Casa de São Paulo, FCMSCSP
Sao Paulo, Sao Paulo, Brazil

Background: HPV vaccine has been freely available through public clinics in Brazil since 2014. Initial policy was to vaccinate girls 11-13 years old, changing to 9-10 years in 2015. In 2017, vaccination for boys aged 9-13 years and for immunosuppressed (including HIV/AIDS) was added. Although not official policy, catch-up vaccination for women of all ages is encouraged. Coverage of HPV vaccination among Brazilian trans women, a group at high risk for STIs, is not known. The objective of the present study is to examine history of receiving HPV vaccination in a large, community-based survey of trans women in Brazil.

Methods: Data are from a cross-sectional survey of trans women recruited by respondent-driven sampling in 5 cities, located in 5 major regional zones of the country, in 2019-2020. Anal and genital swabs were tested for HPV, identifying oncogenic strains. Associations with vaccine coverage were identified using multivariable logistic regression.

Results: The 1,317 trans women recruited included 181 in Campo Grande, 340 in Manaus, 192 in Porto Alegre, 201 in Salvador, and 403 in São Paulo. The sample was 44% pardos (mixed race), 26% Black, 25% white, 1% indigenous, and 2% Asian. History of HPV vaccination was reported by 46%. Compared to São Paulo, vaccination coverage was significantly lower in Campo Grande (adjusted odds ratio [AOR] 0.03, 95%CI 0.02-0.06), Manaus (AOR 0.05, 95%CI 0.03-0.75), and Porto Alegre (AOR 0.08, 95%CI 0.05-0.13). Vaccine coverage was also lower among trans women aged 18-24 years (AOR 0.10, 95%CI 0.07-0.16) compared to those 25 years and older. Vaccine coverage was higher among trans women previously diagnosed with HIV (AOR 1.85, 95%CI 1.30-2.62) and among those with middle school education or less (AOR 1.58, 95%CI 1.02-2.43) compared to greater than high school. At least one strain of HPV was detected in 78% of trans women, of which 92% were oncogenic.

Conclusions: Our data indicate that most trans women in Brazil are not vaccinated for HPV, with significant disparities by city. HPV vaccination policies needs to specifically address young trans women. Trans-friendly sexual health programs are needed to fill the current gap in vaccination for older trans women.