Facilitators and barriers in HIV testing and continuum of care among migrant transgender women who are sex workers residing in Florence, Italy

Filippo Lagi; Claudia Gatteschi; Marta Tilli; Nicoletta Zocco; Angelo Avarello; Sabrina Bellini; Sara Contanessi; Maria Rosa Zigliani; Maria Stagnitta; Lorenzo Mariano; Elena Gazzarri; Laura Belloni; Alessandra Daphne Fisher; Alessandro Bartoloni; Gaetana Sterrantino; Francesca Ierardi

doi:10.1080/26895269.2023.2209072

Facilitators and barriers in HIV testing and continuum of care among migrant transgender women who are sex workers residing in Florence, Italy

Int J Transgend Health. 2023 May 18;25(2):268-282. doi: 10.1080/26895269.2023.2209072. eCollection 2024.

Authors

Filippo Lagi¹, Claudia Gatteschi², Marta Tilli³, Nicoletta Zocco⁴, Angelo Avarello¹, Sabrina Bellini⁵, Sara Contanessi⁴, Maria Rosa Zigliani⁵, Maria Stagnitta⁴, Lorenzo Mariano⁴, Elena Gazzarri⁴, Laura Belloni⁶, Alessandra Daphne Fisher⁷, Alessandro Bartoloni^{1

3}, Gaetana Sterrantino³, Francesca Ierardi²

Affiliations

¹ Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
² Regional Health Agency of Tuscany, Florence, Italy.
³ Department of experimental and clinical medicine, University of Florence, Florence, Italy.
⁴ CAT Cooperativa sociale Firenze, Florence, Italy.
⁵ Lega Italiana per la Lotta contro l'AIDS, LILA Toscana, Florence, Italy.
⁶ Regional Center for Critical Relationships, Careggi University Hospital, Florence, Italy.
⁷ Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy.

Abstract

Background: An increased risk of contracting HIV infection, suboptimal adherence, and a loss to follow-up have been observed in migrants, particularly if those individuals are transgender or sex workers. A clear picture of the HIV epidemic among migrants is complex due to the lack of specific national data.

Aims: We developed a qualitative study that describes the barriers and facilitators (cultural, social, and personal) in HIV testing and the continuum of care for a group of migrant transgender women who are sex workers.

Methods: A semi-structured interview was conducted with a group of migrant transgender women who are sex workers living with HIV or with unknown HIV serostatus residing in the Florentine metropolitan area.

Results: We included 12 participants: 3 had unknown HIV serostatus and 9 were living with HIV in follow-up at the Clinic of Infectious and Tropical Diseases, Careggi University hospiral, Florence, Italy. Among barriers, the perceived stigma due to their identity as migrants and transgender people, the language lack of ability and the legal position in the host country played a significant role. Moreover, the interviewees claimed having no alternative to sex work: for those individuals, changing their lifestyle condition is perceived as difficult or impossible due to social prejudices. Conversely, the interviewees considered support services, such as cultural mediators/interpreters and street units, as facilitators to HIV testing, access to care, and continuum of care. Having regular and accessible ART and the availability of a more consistent health care system, represent reasons for HIV-positive migrants living with HIV to move to Italy.

Conclusions: Knowledge of this population's personal experience regarding the barriers and factors that facilitate access to the HIV care system is essential for planning public health interventions capable of responding to the real needs of patients.

Keywords: HIV; Italy; access to care; illness experience; qualitative research; sex worker; transgender.