Sexually Transmitted Infections (STIs) are a public health issue worldwide, presenting high rates of morbidity and mortality and having a significant impact on quality of life, especially in the most vulnerable population segments such as Transgender Women and Travestis (TGW)¹1. Van Gerwen OT, Jani A, Long DM, Austin EL, Musgrove K, Muzny CA. Prevalence of sexually transmitted infections and human immunodeficiency virus in transgender persons: a systematic review. Transgend Health 2020; 5(2): 90-103. https://doi.org/10.1089/trgh.2019.0053
https://doi.org/10.1089/trgh.2019.0053... . Despite the scarcity of data on STIs in this population group, especially in low- and middle-income countries, such as Brazil, existing studies, generally related to HIV, indicate that this is one of the most affected populations.

In this sense, the TransOdara study aimed to estimate the prevalence of the most relevant STIs among TWT in Brazil and to investigate issues related to illness and the search for care, in order to produce knowledge of their health conditions and psychosocial aspects, as well as to foster improvements in their relationship with healthcare services. This study was designed and implemented in partnership with public research institutions in the different macro-regions of the country and it was funded by the Brazilian Ministry of Health and the Pan American Health Organization (PAHO).

TransOdara was the name proposed by a group of TWT specially gathered to discuss the visual identity of the study. The initial portion of the name specifies the target population for the research and indicates its aim to encompass a wide range, including regional, of identity nominations. In Brazil, the term “trans” has been employed as a broad term for individuals with gender identities and expressions that do not align with their sex assigned at birth. The research specifically examined the segment of this population that identifies with the female spectrum. In turn, the term ‘Odara,’ of Yoruba origin, was incorporated into pajubá, a “dialect” developed by Brazilian travestis2, expressing connotations of positivity, beauty, prosperity, and wonder (as in the famous Caetano Veloso’s music), the term translates the participants’ expectations regarding the study.

Conducting research with the transgender population, from the perspective of social justice and the universal right to health³3. United Nations. Discussion paper. Transgender health and human rights [Internet]. New York: United Nations; 2013 [cited on Mar. 11, 2024]. Available at: https://www.undp.org/sites/g/files/zskgke326/files/publications/Trans%20Health%20&%20Human%20Rights.pdf
https://www.undp.org/sites/g/files/zskgk... , calls for a dialogue with its questions and claims, as well as to foster the implementation of the results in concrete interventions capable of providing advances and answers. In this sense, despite the challenges posed by the simultaneous occurrence of the new coronavirus (COVID-19) pandemic and the fieldwork targeting a vulnerable and spatially dispersed population⁴4. Lescure TN, Stewart J, Sperring H, Ruiz-Mercado G, Taylor JL. Impact of COVID-19 on sexually transmitted infection and HIV screening at an urban safety-net hospital. AIDS Patient Care STDS 2023; 37(4): 199-204. https://doi.org/10.1089/apc.2022.0220
https://doi.org/10.1089/apc.2022.0220... , the study produced important data for the knowledge of the health conditions of TWT in Brazil and to inform public policies specific for this population. At the same time, it has structured, together with the partner healthcare services, the provision of qualified, agile, and attentive care to the health issues of this population in five Brazilian capitals: Manaus, Salvador, Campo Grande, Porto Alegre, and São Paulo.

This special issue presents the main results of the research in its quantitative-qualitative approach, aiming to foster the debate on health issues among TWT. In the first article, the authors describe the methodological bases of TransOdara, its design, and the collaborative efforts of different teams of researchers, in addition to characterizing the participants in relation to sociodemographic and behavioral aspects. Authors of the following articles provide the prevalence of the investigated STIs among TWT, namely: syphilis⁵5. Rocha ABM, Sperandei S, Benzaken A, Bacuri R, Bassichetto KC, Oliveira EL, et al. Prevalence of syphilis in transgender women and travestis in Brazil: results from a national cross-sectional study. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240003.supl.1. https://doi.org/10.1590/1980-549720230003.supl.1
https://doi.org/10.1590/1980-54972023000... , HIV⁶6. Dourado I, Magno L, Leite BO, Bastos FI, Mota JC, Veras MASM, et al. Prevalence of HIV infection among transgender women and travestis in Brazil: data from the TransOdara study. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240004.supl.1. https://doi.org/10.1590/1980-549720230004.supl.1
https://doi.org/10.1590/1980-54972023000... , viral hepatitis⁷7. Moreira RC, Veras MASM, Amianti C, McCartney DJ, Silva VCM, Lemos MF, et al. Hepatitis A, B and C prevalence among transgender women and travestis in five Brazilian capitals between 2019-2021. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240005.supl.1. https://doi.org/10.1590/1980-549720240005.supl.1
https://doi.org/10.1590/1980-54972024000... , chlamydia and⁸8. Bassichetto KC, Sperandei S, McCartney DJ, Luppi CG, Silva RJC, Araújo S, et al. Prevalence of chlamydia and gonorreheae among transgender women and travestis in five Brazilian capitals, 2019–2021. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240006.supl.1. https://doi.org/10.1590/1980-549720240006.supl.1
https://doi.org/10.1590/1980-54972024000... . In short, they present prevalences or exposure markers higher than those estimated for the general population in Brazil and demonstrate that access to vaccines or other prevention technologies is low, underlining the context of TWT vulnerability and pointing out individual and socio-behavioral factors associated with such infections.

In addition, authors of another article⁹9. Pinheiro TF, Carvalho PGC, Nolasco G, Santos LA, Veras MASM. Difficulties and advances in access and use of health services by transgender women and travestis in Brazil. Rev Bras Epidemiol. 2024; 27: e240007.supl.1. https://doi.org/10.1590/1980-549720240007.supl.1
https://doi.org/10.1590/1980-54972024000... reiterate the difficulties faced by TWT in the search for health care, but also point to a positive ongoing change through the expansion of the availability of services and the improvement of care. The article on testing for STIs¹⁰10. Leite BO, Dourado I, Magno L, Sperandei S, Luppi CG, Veras MA. Factors associated with previous testing for HIV, Syphilis, and Hepatitis B and C among transgender women and travestis in Brazil. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240008.supl.1. https://doi.org/10.1590/1980-549720230008.supl.1
https://doi.org/10.1590/1980-54972023000... highlight the need to expand access and bonding of TWT to healthcare services to reduce the transmission of HIV and other STIs. Conversely, authors of the article on the acceptability of physical examinations for the detection of STIs¹¹11. McCartney DJ, Carvalhal LG, Moraes CA, Mayaud P, Veras MASM. Physical examination for the detection of sexually transmitted infections among transgender women and travestis in Brazil: acceptability and associated factors. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240009.supl.1. https://doi.org/10.1590/1980-549720240009.supl.1
https://doi.org/10.1590/1980-54972024000... explain that a gender affirmation perspective should be incorporated to carry out physical examinations with TWT.

A last set of articles refer to other relevant topics to understand the relationship of TWT with health, illness, and care processes. The first¹²12. Bassichetto KC, Pinheiro TF, Barros C, Fonseca PAM, Queiroz RSB, Sperandei S, et al. Bodies of desire: use of nonprescribed hormones among transgender women and travesties in five Brazilian capitals (2019–2021). Rev Bras Epidemiol. 2024; 27: e240010.supl.1. https://doi.org/10.1590/1980-549720240010.supl.1
https://doi.org/10.1590/1980-54972024001... demonstrates that the use of nonprescription hormones is still very high, showing limitations in access to care related to gender transition. In another¹³13. Mota JC, Sperandei S, De Boni RB, Dourado I, Veras MASM, Bastos FI. Multiple substance use and associated factors in transgender women and travestis: findings from the TransOdara Study, Brazil. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240011.supl.1. https://doi.org/10.1590/1980-549720230011.supl.1
https://doi.org/10.1590/1980-54972023001... , the authors observed an intense and diversified use of psychoactive substances, associated with other social markers of difference such as unstable housing. Authors of another article¹⁴14. Magno L, Leite BO, Sperandei S, Pereira M, Knauth DR, Leal AF, et al. Discrimination based on gender identity against transgender women and travesties in Brazil: a latent class analysis and associated factors. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240012.supl.1. https://doi.org/10.1590/1980-549720240012.supl.1
https://doi.org/10.1590/1980-54972024001... present a high proportion of gender identity discrimination among TWT, associated with greater vulnerability and history of violence. In another article¹⁵15. Hentges B, Martins RS, Silva JRP, Hübner DPG, Leal AF, Teixeira LB, et al. Lifetime sexual violence among transgender women and travesties (TGW) in Brazil: Prevalence and associated factors. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240013.supl.1. https://doi.org/10.1590/1980-549720240013.supl.1
https://doi.org/10.1590/1980-54972024001... , more than half of the study participants had already been victims of sexual violence, a phenomenon also associated with greater socioeconomic vulnerability including having no place to live; still, most did not seek help from healthcare services. Lastly¹⁶16. Leal AF, Cazeiro CC, Mattos ACE, Hentges B, Teixeira LB, Knauth DR, et al. Profile and experiences during the incarceration of transgender women and travesties (TGW) in Brazil: a cross-sectional study. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240014.supl.1. https://doi.org/10.1590/1980-549720240014.supl.1
https://doi.org/10.1590/1980-54972024001... , an article addressed the experience of incarceration and found a relatively high proportion of TWT who were deprived of liberty, a situation in which they report having suffered physical, sexual, and moral violence.

We hope that the publication of these results will contribute to boosting the STI prevention agenda for TWT, drawing the attention of all those interested in the subject, including public health authorities, to the specific needs of this population group.

ACKNOWLEDGEMENTS

The authors would like to thank the transgender women and travestis who participated in the TransOdara Study and to the team of professionals from the Ministry of Health – Department of Diseases of Chronic Conditions and Sexually Transmitted Infections (Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis– DCCI) and the Pan American Health Organization (PAHO).

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