Papers by Virginia Zalazar
PLoS ONE, Aug 18, 2014
Introduction: In May 2012, Argentina passed its ''Gender Identity'' Law, which aimed to address t... more Introduction: In May 2012, Argentina passed its ''Gender Identity'' Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina. Methods: Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law. Results: Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27-3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58-5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06-3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06-0.33). Conclusions: More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreignborn status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina.
International Journal of STD & AIDS, 2021
Background: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests... more Background: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. Methods: A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. Results: We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested ...
Perspectivas en Psicología, 2020
Las personas transgenero muestran prevalencias de problemas de salud mental significativamente mu... more Las personas transgenero muestran prevalencias de problemas de salud mental significativamente muy superiores a las del resto de la poblacion. Esto se debe, en gran parte, al estigma y la discriminacion que padecen y al contexto de vulnerabilidad psicosocial en el que estan insertas. El objetivo de este trabajo es presentar una sistematizacion y sintesis de los hallazgos cientificos mas recientes y relevantes acerca de la salud mental en personas transgenero, a nivel internacional y local. En primer lugar, se analizan los cambios ocurridos en las categorias diagnosticas en el sentido de la despatologizacion de las identidades trans. A continuacion, se exponen las prevalencias mas actuales acerca de problemas de salud mental en esta poblacion, asi como los principales factores de riesgo y proteccion que impactan en su desarrollo. Finalmente, se discuten las limitaciones mas significativas de los estudios disponibles en salud mental en personas transgenero en el contexto regional y lo...
Actualizaciones en Sida e Infectología, 2018
Introducción: Las mujeres transgénero (MT) son vulnerables a diversos problemas de salud, incluye... more Introducción: Las mujeres transgénero (MT) son vulnerables a diversos problemas de salud, incluyendo el virus de la inmunodeficiencia humana (VIH) y otras infecciones de transmisión sexual (ITS), que reducen significativamente su expectativa de vida. Consecuentemente, existe la necesidad de entender los factores que afectan su acceso a la salud. Métodos: Se realizó una investigación cualitativa en MT que viven en alojamientos comunitarios (HT, hoteles trans) en Buenos Aires. El objetivo del estudio fue explorar las barreras y facilitadores contextuales, sociales e individuales para el acceso a la salud, particularmente los servicios de VIH, y la aceptabilidad de diferentes intervenciones. Se realizaron dos grupos focales y cinco entrevistas en tres hoteles trans. Resultados: Las barreras contextuales descriptas fueron los turnos limitados y las largas horas de espera. Los obstáculos sociales incluyeron el estigma y la discriminación por parte del personal y la culpabilización de las...
Psicodebate, 2017
The expression of stigma related to HIV is culturally determined and has changed through decades,... more The expression of stigma related to HIV is culturally determined and has changed through decades, assuming subtler, but still harmful forms. Therefore, aiming at assessing this construct, updated instruments that capture its particularities in specific contexts should be designed. Most theoretical frameworks recognize three dimensions of stigma: internalized, anticipated and enacted. The objectives of this study were: to explore an initial set of items of a new measurement of stigma, to obtain evidence of reliability and validity, and to describe the levels of stigma among adults with HIV from Buenos Aires city. Five experts evaluated the clarity, relevance and content validity of 88 preliminary items. A depurated version of 77 items was administered to a pilot sample. The statistical analysis included a descriptive item analysis, Cronbach´s alphas to evaluate reliability and, to establish criterion-related validity, correlations with the HIV Stigma Scale. The final sample consisted...
Journal of Gay & Lesbian Mental Health, 2021
Introduction Transgender women (TGW) experience high prevalence of depression worldwide. Methods ... more Introduction Transgender women (TGW) experience high prevalence of depression worldwide. Methods This study analyzed the prevalence and correlates of depressive symptoms among 61 HIV + TGW (age: M = 29.87 years, SD = 6.51) from Argentina; through questionnaires assessing psychosocial vulnerability, gender identity stigma (GIS) and violence, mental health, substance use, and protective factors. Results Half of the respondents showed significant depressive symptoms. In the multivariable logistic regression model, unstable housing, GIS from police, anxiety, and lifetime suicide attempts predicted increased odds of depressive symptoms. Conclusion The role of institutional GIS and psychosocial vulnerability in the development of depression should be considered in HIV and mental health care for TGW.
Psicología y Salud
Este estudio cualitativo tuvo como objetivo explorar los significados atribuidos al virus de inmu... more Este estudio cualitativo tuvo como objetivo explorar los significados atribuidos al virus de inmunodeficiencia humana (VIH) y la experiencia de cambios positivos posteriores al diagnóstico (crecimiento postraumático) en hombres gays de Buenos Aires, Argentina. Se efectuaron catorce entrevistas individuales en profundidad. Se implementó un análisis temático asignando códigos a fragmentos de transcripciones y organizándolos en temas. La edad media de los participantes fue de 41.29 (D.E.=11.97) y una media de 8.42 (D.E.=7.08) años desde el diagnóstico, tres de los cuales lo habían recibido en el último año. La mayoría informó cambios positivos que atribuyeron al diagnóstico de VIH, los que se organizaron en tres temas: Cambios en la filosofía de vida, Cambios en las relaciones con los otros y Cambios en la percepción de sí mismos. Algunos de estos incluyen mayor aprecio por la vida y su salud, incremento de comportamientos más saludables, fortalecimiento de la red de apoyo social y con...
International Journal of Behavioral Medicine, 2021
Transgender women (TGW) consistently show lower adherence to antiretroviral treatment (ART), than... more Transgender women (TGW) consistently show lower adherence to antiretroviral treatment (ART), than cisgender people (CP) living with HIV. This study examined sociodemographic and psychosocial factors associated with gender identity among individuals disengaged from HIV care in Argentina. Data for this study was obtained at baseline from the Conexiones y Opciones Positivas en la Argentina 2 (COPA2) study. Forty-one TGW and 360 CP (177 male, 183 female) disengaged from HIV care completed questionnaires assessing sociodemographic information, severity of depressive symptoms, substance and alcohol use, patient-provider relationship quality, self-efficacy, ART adherence motivation, self-reported adherence, and treatment-related factors. Analyses included chi-square tests exploring the association between categorical variables and gender identity, and ANCOVAs comparing groups controlling for age. Being a TGW was associated with having only public health insurance; substance use, particular...
International Journal of Mental Health
Culture, Health & Sexuality
PLOS ONE
Background In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. T... more Background In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW. Methods A multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4 th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis. Results A total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4 th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously.
BJPsych international, 2015
Studies regarding stigma towards mental illness in Argentina blossomed after the first National M... more Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.
Journal of health psychology, 2017
The stigma related to HIV status, gender identity, and sexual orientation has negative implicatio... more The stigma related to HIV status, gender identity, and sexual orientation has negative implications for the quality of life of individuals. A qualitative study was conducted to explore the resources that these stigmatized groups recognize as tools to cope with stigma and maintain their psychological well-being. Four focus groups were conducted with gay men and transgender women divided by HIV status. A thematic analysis revealed that individual, interpersonal, and institutional resources are commonly recognized as coping resources. This article discusses the importance of enhancing self-acceptance, social support, and a legal framework that legitimizes these groups as right holders.
International Journal of Transgenderism
Transgender Health
In Argentina, transgender women face a disproportionately high prevalence of HIV infection (34%).... more In Argentina, transgender women face a disproportionately high prevalence of HIV infection (34%). Although not currently approved in Argentina, pre-exposure prophylaxis (PrEP) may offer a potential effective HIV prevention tool for this population. In this study, we assessed the willingness to use PrEP among transgender women in Argentina. Methods: Data were drawn from a nationwide cross-sectional survey conducted among transgender women in 2013. Using multivariable logistic regression, we assessed the prevalence of and factors associated with willingness to use PrEP among transgender women with negative or unknown HIV status. Results: This study included 337 transgender women (278 HIV negative and 59 with unknown HIV status), most of whom had a history of sex work involvement (81.8%). Overall, 301 (89.3%) expressed willingness to use PrEP. In a multivariable analysis, having casual sexual partners was positively associated with willingness to use PrEP (adjusted odds ratio [AOR] = 4.26, 95% confidence interval [CI] 1.73-10.51), while discrimination by healthcare workers was negatively associated (AOR = 0.33, 95% CI 0.12-0.88). Conclusion: We found high levels of willingness to use PrEP among transgender women in Argentina, suggesting that there is high perception of HIV risk in this population. However, discrimination by healthcare workers was a strong negative correlate of willingness to use PrEP, suggesting that multilevel interventions that address gender-based stigma in healthcare settings will be critical for the success of PrEP as an HIV prevention strategy in this population.
Journal of Psychosocial Rehabilitation and Mental Health
Journal of mental health (Abingdon, England), Jan 13, 2017
Scarce information is available about how users experience treatment at mental health day hospita... more Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America. To explore users' perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina. Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques. Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in ter...
AIDS care, Jan 27, 2016
Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent... more Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the in...
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Papers by Virginia Zalazar