BackgroundIn the United States, approximately one-fifth of transgender women are living with HIVnearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men. Methods and findingsWe assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92-0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41-0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42-0.73, p < 0.001).

• Implementation science has emerged as an essential field for HIV treatment and prevention, promising to maximize the impact of effective intervention strategies to prevent transmission of the virus and to link and retain people with HIV in care.

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Although recent scholarship focuses on the increasing significance of processes of standardization in contemporary social life, much less attention has been given to how standardization impacts intimate life, and how intimate standards are made meaningful in interaction. This article draws from participant observation in online transgender groups to examine how the medical standardization of transsexuality, known as the 'wrong-body' model, impacts the way users understand and communicate their gendered self. I show how rather than simply adopting the wrong-body model, participants use its language and logic in ironic and playful ways that carve out spaces for ways of knowing the self that feel authentically their own. This case shows how intimate standards become part of the language of the self in ways that may be unexpected.