LÉO RAMOSQuestionnaire used by the Muriel Project for transvestites and transsexuals who live in São Paulo StateLÉO RAMOS
A group of public health researchers has adopted a strategy not commonly used in other fields to disseminate its research findings. After completing a study according to which the prevalence of HIV infection remains high (15.4%) among homosexuals and transvestites who frequent bars, clubs and other venues where they socialize in the central region of São Paulo, the researchers decided to release the study findings to the public and government agencies even before they were published in scientific articles. The initiative is part of the SampaCentro Project, which brings together researchers from the School of Medical Sciences of the Santa Casa, the São Paulo State Department of Health, the University of Campinas (Unicamp), the University of São Paulo (USP), the Adolfo Lutz Institute, the Oswaldo Cruz Foundation (Fiocruz) and nongovernmental organizations.
“As soon as we analyzed the data and organized the information, we held meetings with the individuals who took part in the study, with civil society organizations and with public health workers to alert them to the high infection rates and the need for prevention policies that focus on the group of subjects that were studied,” says Maria Amélia de Sousa Mascena Veras, professor at the Santa Casa and coordinator of 2011 – 2012 study that was only published in the journal AIDS and Behavior last November. “We disseminated the findings at scientific events and through social networks,” Veras notes.
One of the reasons for the rush to present the study is that many of the participants did not know they were infected with the AIDS virus. After the interviews were conducted, the 1,217 men who have sex with men were invited to have their blood drawn for an HIV test. Of this total, 771 agreed to have their blood tested, and 118 of them, or 15%, were found to be infected with the virus. Of this number, 54 stated that they already knew they were HIV positive while the others (64) did not. “The process of publishing an article can take months. In public health, the sooner we release the information to the subjects of the study and to the public health authorities, the better our chances of influencing decision-makers and developing policies to fight AIDS,” Veras says. The purpose of the 2011-2012 survey was to estimate the prevalence of the HIV virus in the homosexual and transvestite population and determine whether members of this population have access to prevention, whether they have faced discrimination, and which venues they frequent to socialize.
The study shows that the percentage of infection among the individuals studied in the central region of São Paulo is high (6.4%) among the youngest subjects (men between the ages of 18 and 24) and among lower-income men. Other information contributes to painting a more complete picture: 63% of the subjects interviewed considered themselves white; 57% did not finish high school; 60% said they had been discriminated against in one form or another, and 30% stated they had had sex while under the influence of drugs, which raises the risk of exposure to sexually transmitted diseases. Based on the data obtained, Veras says, we can learn more about this population and act more efficiently and aggressively when designing prevention policies.
Developments
Another initiative of the group is the Muriel Project, which is designed to study how vulnerable female and male transvestites and transsexuals are. Sociodemographic data and data on access to health and education rights and services are evaluated. The project is underway and is expected to end next year. To date, 259 individuals have been interviewed: 77% completed high school and 23% stated that they are carriers of HIV. This and other information is being released in the form of preliminary findings on the project web site. Meetings are being held with interested parties, nongovernmental organizations and government agencies to improve the services provided to this group.
“The lack of accurate information on transvestites and transsexuals is preventing the development of policies more tailored to this group, says Brunna Valim, 40, an activist in the LGBT/AIDS movement who works for the São Paulo Center of Reference and Advocacy for Diversity. In addition to being a member of the group studied by the Muriel Project, Valim assisted the team of researchers in drafting the questionnaire that was used in several cities in São Paulo State. “The data up to this point show that transvestites and transsexuals require care that transcends treatment for AIDS once they have the disease. This population needs better basic health services,” Valim adds.
For Ana Maria Costa, president of the Brazilian Center for Health Studies (CEBES), projects such as the ones carried out in São Paulo are the core of collective health research. “This is a field of science that is based on the commitment to the right to health,” Costa says. In her opinion, many public health research projects conducted in Brazil usually generate reports, assessments, books and conference proceedings. These types of documents are not always published in scientific journals. This is another factor that helps explain why researchers are opting for other ways to disseminate partial and final findings. To monitor this series of information that skirts traditional periodicals, a group of researchers from the Federal University of Bahia (UFBA) recently created the National Health Policies Observatory. This entity will track and provide access to studies that were not initially published in the form of scientific articles, but that contain important data for managing public health.
Projects
1. Sexual behaviors and practices, access to prevention, prevalence of HIV and other sexually transmitted infections among gay men, transvestites and men who have sex with men (MSM) in the central region of São Paulo (09/53082-9); Grant mechanism: Application-oriented Research Program in Public Policies for the National Health Care System (PPSUS); Principal investigator: Maria Amélia de Sousa Mascena Veras (Santa Casa de São Paulo); Investment: R$326,835.63 (FAPESP).
2. Vulnerabilities, health needs and access to health services of transvestites, transsexual and transgender population of the state of São Paulo (13/22366-7); Grant mechanism: Regular line of research project award; Principal investigator: Maria Amélia de Sousa Mascena Veras (Santa Casa de São Paulo); Investment: R$330,016.70 (FAPESP).
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