Stigma and Barriers to Healthcare Access Among Transvestites and Transgender Women Living With Hiv in Brazil: Analysis of Data From the 2025 Stigma Index

Transvestites and transgender women constitute one of the most vulnerable groups in the HIV/AIDS response, facing layers of exclusion marked by structural inequalities, gender-based violence, and institutional discrimination. This study aims to analyze data from the 2025 Stigma Index in Brazil, focusing on experiences of stigmatization, social exclusion, and barriers to healthcare access faced by trans women and transvestites living with HIV. Descriptive epidemiological study based on secondary analysis of microdata from the “Stigma Index Regarding People Living with HIV/AIDS – Brazil 2025,” applied in seven Brazilian capitals. Variables related to gender identity, experiences of stigma and discrimination, internalized stigma, rights violations, and barriers to healthcare were analyzed, including only participants who self-identified as transvestites, trans women, transfeminine, or transgender. Among 1,275 people interviewed, 137 identified as transvestites (n = 66) or trans women (n = 71), representing 10.8% of the sample. A high prevalence of structural stigma was observed, including social exclusion (23%), discrimination in healthcare services (35.7%), and verbal or physical harassment (17%). In addition, 22% reported avoiding romantic relationships, and 20.8% reported social isolation. Internalized stigma was high: 61.9% reported feeling ashamed and 75.6% concealed their serological status. Delayed treatment initiation and negative experiences with healthcare professionals were frequent. The study highlights the persistence of social and institutional exclusion of transvestites and transgender women living with HIV. Multiple forms of stigma undermine care, treatment adherence, and personal dignity. It is essential to strengthen public policies that incorporate an intersectional approach, ensuring equitable access to services as well as comprehensive respect for gender identity.