Male Transvestite Sex Workers and HIV in Rio De Janeiro, Brazil
Inciardi, James A, Surratt, Hilary L, Journal of Drug Issues
The aims of this study were to assess the prevalence of HIV-1 infection among a group of transvestite prostitutes in Rio de Janeiro and to identify HIV-related risk behaviors to develop targeted intervention strategies. A total of 46 transvestite sex workers were recruited and assessed regarding drug use and sexual risk behaviors. Sixty-three percent tested positive for antibody to HIV-I. Injection drug use was the only factor statistically related to HIV seropositivity. However, sexual risk behaviors, including unprotected anal sex and sex for drug exchanges, were reported by a substantial part of the sample. In addition, given that they engage in both receptive and insertive anal sex with a primarily heterosexual male clientele, they may be playing a role in the heterosexual spread of HIV/AIDS in Brazil. The results of this study suggest that transvestite sex workers are at uniquely high risk for HIV infection and that intervention efforts for this population must be equally unique.
In 1990, the Community Research Branch of the National Institute on Drug Abuse (NDA) established the Cooperative Agreement for an AIDS CommunityBased Outreach/Intervention Research Program. The overall purposes of the research program were to: (1) monitor risk factors and behaviors, and rates of HIV seroprevalence and seroincidence among out-of-treatment drug users; (2) evaluate the efficacy of controlled experimental interventions designed to prevent, eliminate, or reduce HIV risk behaviors; and (3) respond rapidly to emerging HIV-related issues and implement interventions to prevent the further spread of HIV and AIDS. Data collection had begun on the initial projects in early 1992, and by mid-1994 the program had grown to a total of 23 sites, from Anchorage to Miami and from San Juan to Rio de Janeiro.
The Rio de Janeiro site was funded, in great part, because of the high rates of HIV and AIDS in Brazil. As illustrated in table 1, almost 80,000 cases of AIDS had been reported to the World Health Organization (WHO) by the beginning of 1996, making Brazil the number three country in terms of officially documented cases. The great majority of cases among men have occurred with injection drug users and men who have sex with men (fig. 1), and among women through injection drug use and heterosexual transmission (fig. 2).
Known as PROV[VA (Projeto Venha Informar-se sobre o Virus da AIDS), the Rio de Janeiro based prevention effort has the general purposes of establishing a community-based HIV/AIDS surveillance and monitoring system, and developing and evaluating a culturally appropriate prevention and intervention program for cocaine injectors and snorters, and transvestite sex workers, in Rio de Janeiro's favelas (shanty towns) and red light districts.
PROVIVA has been in the field since March 1994, and by mid-1996 almost a thousand clients had been recruited. Included among these is a subsample of 46 male transvestite sex workers (travestis). Transvestites were added as targets for prevention and intervention after the initiation of the project because of their visibility on the streets of Rio de Janeiro in areas where rates of drug use are high, and because of preliminary data describing their risks for HIV infection in several Brazilian cities (Suleiman et al. 1989; Grandi et al.1993; Mott 1994; Szterenfeld et al. 1994; Goihman et al. 1994). The characteristics, risk behaviors, and serostatus of these male transvestite sex workers are presented in this paper.
The travestis in Brazil, as in other cultures, are marked by an exaggerated femininity in both dress and makeup. They come almost exclusively from the poorest segments of Brazilian society, but there is little toleration for them in either the favelas or the traditional, low income suburban areas. Thus, as they begin to cross the lines of gender, most leave behind family and friends, emigrating to Rio de Janeiro, Sao Paulo, and other large cities into districts where: