{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T17:44:13Z","timestamp":1775497453313,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A secondary analysis was conducted with a sub\u2010sample of participants recruited from a 2019 respondent\u2010driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio\u2010demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236\/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi\u2010square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20\u201326). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family\/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non\u2010injection drug use (38.3% vs. 20.2%) than non\u2010feminine presenting TGW (all <jats:italic>p<\/jats:italic>\u2010value &lt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender\u2010affirming, psychosocial and legal support services for TGW, might mitigate risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26231","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T03:53:55Z","timestamp":1713326035000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Social and structural drivers of HIV vulnerability among a respondent\u2010driven sample of feminine and non\u2010feminine presenting transgender women who have sex with men in Zimbabwe"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-5811","authenticated-orcid":false,"given":"Lauren E.","family":"Parmley","sequence":"first","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia S.","family":"Miller","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Innocent","family":"Chingombe","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7777-9492","authenticated-orcid":false,"given":"Munyaradzi","family":"Mapingure","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Mugurungi","sequence":"additional","affiliation":[{"name":"Zimbabwe Ministry of Health and Child Care  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John H.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-4429","authenticated-orcid":false,"given":"Godfrey","family":"Musuka","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chesterfield","family":"Samba","sequence":"additional","affiliation":[{"name":"Gay and Lesbians of Zimbabwe  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6754-6241","authenticated-orcid":false,"given":"Avi J.","family":"Hakim","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2212-0874","authenticated-orcid":false,"given":"Tiffany G.","family":"Harris","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"},{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001087"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(12)70315-8"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260063"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.18356\/9789210019798"},{"key":"e_1_2_12_6_1","volume-title":"HIV and transgender and other gender\u2010diverse people: human rights fact sheet series","author":"UNAIDS","year":"2021"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-14593-6"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60931-4"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30217-X"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(15)00078-8"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(22)00336-8"},{"key":"e_1_2_12_12_1","volume-title":"Country Policy and Information Note\u2010Zimbabwe: sexual orientation and gender identity and expression","year":"2019"},{"key":"e_1_2_12_13_1","volume-title":"Laws and policies affecting transgender persons in Southern Africa","year":"2017"},{"key":"e_1_2_12_14_1","unstructured":"NdhlovuL.Trans people struggle for acceptance in Zimbabwe.2018. 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