Dear Editor

Transgender women are among the five most vulnerable populations at risk of acquiring Human Immunodeficiency Virus (HIV). About 2% of the Brazilian adult population is made up of transgender and non-binary people, that is, people who identify with a gender other than the one assigned to them at birth or do not perceive themselves as belonging exclusively to the female or male gender(1), respectively. In Brazil, there are few studies on the epidemiology of HIV infection in transgender women, most of which were carried out in the Southeast and South regions and demonstrated a high prevalence of infection, as well as a high level of social discrimination, which directly interferes with seeking public health services(2). Gender-based discrimination plays an essential role in reducing transgender women's accessibility to medical consultations and HIV testing, which certainly hinders their access to public health services. Therefore, these data point to the urgent need for non-discriminatory public policies, based on the defense and promotion of human rights, which could favor this accessibility.

In Brazil, since 2004, it is celebrated annually, on January 29, the pride, existence, awareness and resistance of the trans and transvestite community, within the LGBTQIA+ movement. Although, a National LGBTQIA+ Comprehensive Health Policy was instituted almost a decade later in 2011, the country has been the most violent for 14 consecutive years with a record of 133 trans people murdered in 2022 alone. Brazil knows little about who and where these people are, because the methodology applied to the collection of data from the demographic census, carried out every ten years, does not include questions about gender identity, which leads to the exclusion of transgender people from the profile of inhabitants of our territory(3).

On this topic, even with the notorious Brazilian advance in the incorporation of health technologies for combined prevention, decentralization of diagnosis, treatment and monitoring of people living with HIV, it was observed that only 6% of users of post-exposure prophylaxis (PEP) identified themselves(4). Of the nearly 50,000 people using pre-exposure prophylaxis (PrEP) in the country, just 4.8% were identified as trans or non-binary people, confirming that gender-based discrimination prevents for the transgender public from medical appointments and HIV testing services(2,5).

In the Brazilian Amazon region, which is composed of seven states from the North and has the largest territorial area in the country, there is no official information on the prevalence of infection, not only HIV but other STIs, in the population of transgender women. As a result, our research group draws the attention of Brazilian authorities to the need for public research calls to fill the gap regarding knowledge of HIV epidemiology in transgender women, in order to subsidize public policies to face the epidemic in the region.