Cannabis, Cocaine and Crack Before or During Sex and Inconsistent Condom Use with Casual Partners Among Transgender Women in Brazil: A Cross-Sectional Study.

Background: Transgender women and travestis (TWT) in Brazil have a disproportionately high prevalence of psychoactive substance use, contributing to increased vulnerability to sexually transmitted infections (STI). The use of substances before or during sex has been linked to risky sexual behaviors but remains understudied among TWT in Latin America. Objective: To investigate the association between the use of cannabis, cocaine, or crack before or during sex and inconsistent condom use with casual partners among TWT. Results: We analyzed data from 533 TWT in the TransOdara study (2019-2021), who reported penetrative sex with casual partners in the past six months. Methods: In the previous year, 47.8% used cannabis, 37.3% cocaine, and 8.1% crack - mostly before or during sex. Inconsistent condom use was reported by 48.9%. Cocaine (PR: 1.40; 95% CI: 1.16-1.70) and crack (PR: 1.42; 95% CI: 1.06-1.91) use during sex were associated with higher inconsistent condom use, while cannabis showed no association. Discussion and Conclusions: These findings underscore the need for targeted public health interventions that address the intersection of substance use and sexual health risks among TWT in Brazil. In particular, drug use specifically before or during sex should be prioritized in research on sexual behavior.