title: HIV prevention among transgender women in Latin America: implementation, gaps and challenges.
abstract: Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America.
  
  
  
  We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations.
  
  
  
  Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws.
  
  
  
  Transgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.
authors.affiliation: Center for Interdisciplinary Research on Sexuality, AIDS and Society, Cayetano Heredia University, Lima, Peru; alfonsoss@upch.pe.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Silva-Santisteban
authors.affiliation: Regional Support Team for Latin America, UNAIDS, Panama City, Panama.
authors.forename: Shirley
authors.initials: S
authors.lastname: Eng
authors.affiliation: Horizontal Cooperation Technical Group for Latin America and the Caribbean, Buenos Aires, Argentina.
authors.forename: Gabriela
authors.initials: G
authors.lastname: de la Iglesia
authors.affiliation: Horizontal Cooperation Technical Group for Latin America and the Caribbean, Buenos Aires, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Falistocco
authors.affiliation: HIV and Sexually Transmitted Infections, Pan American Health Organization, Washington, DC, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mazin
mesh_terms: D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007843:Latin America; D008297:Male; D011314:Preventive Health Services; D063106:Transgender Persons
keywords: HIV prevention; Latin America; PrEP; prevention; transgender women