Correlates of Engagement in HIV Care Among Transgender Women of Color in the United States of America

Abstract

HIV prevalence among transgender women of color (TWC) in the United States of America is high. We enrolled TWC living with HIV (N = 858) to evaluate 1nine HIV care interventions. We examined factors associated with four outcomes at enrollment: linkage to care, ever being on antiretroviral treatment, retention in care and viral suppression. The sample was 49% Hispanic/Latino, 42% Black; average age was 37 years; 77% were ever linked to care, 36% were ever on treatment, 22% were retained in care, and 36% were virally suppressed. Current hormone use was significantly associated with linkage, retention, and viral suppression (all aORs > 1.5), providing evidence for gender-affirming care as an important facilitator of engagement in HIV care. Greater health care empowerment was significantly associated with greater odds of all outcomes (aORs between 1.19 and 1.37). These findings identify potential intervention targets to improve the provision of care and treatment for TWC living with HIV.

Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California

“…This finding is consistent with studies that have found that receiving quality, affirming health services in a welcoming and trans-friendly environment was associated with increased engagement in sexual health services 42 and where trans clients can connect and derive support from one another as well as from their providers. 64,65 Gender affirmation 43 and healthcare empowerment 66 have been shown to moderate the deleterious impact that trans-related discrimination has on rates of viral suppression among Black and Latinx TGW with HIV. 67 Guidelines for gender-affirming care of trans and non-binary people include ensuring a safe and welcoming environment by utilizing a patient's gender identity, and taking a gender-affirming approach for any physical exams.…”

Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV

“…7 As with other populations, trans women living with HIV who are suboptimally engaged in HIV care are at increased risk for negative health outcomes, such as unsuppressed viral load and increased risk of HIV transmission. 3,8…”

“…2 Furthermore, trans women living with HIV exhibit suboptimal advancement through the HIV care continuum. 3 Compared with other groups, trans women living with HIV are less likely to be retained in HIV care 3 and receive antiretroviral therapy (ART) 4 ; trans women on ART demonstrate lower levels of adherence 5 and higher viral loads. 6 Furthermore, trans women report less confidence in their ability to integrate treatment regimens into their daily lives.…”

“…7 As with other populations, trans women living with HIV who are suboptimally engaged in HIV care are at increased risk for negative health outcomes, such as unsuppressed viral load and increased risk of HIV transmission. 3,8 HIV care engagement among trans women living with HIV is complicated by a complex array of psychosocial challenges, including intersectional stigma (ie, the confluence of multiple forces of stigma and oppression, such as racism, transphobia, HIV stigma), discrimination, lack of access to gender-affirming healthcare, and distrust of healthcare providers and institutions because of past negative experiences. 9,10 These challenges may result in late or no presentation to HIV care, leading to poor health outcomes.…”

“…22,23 Healthcare empowerment (ie, a sense of being informed, engaged, collaborative and committed to one's health care) 24 and current hormone use have both been found to be positively associated with HIV care engagement among trans women living with HIV. 3 At the individual level, gender-affirming, peer-led interventions may be one of the most effective strategies for improving care engagement and health outcomes among trans women living with HIV. 22,25,26 Gender-affirming interventions should include social gender affirmation, for example, ensuring the use of correct names and pronouns, honoring diversity in clients' gender identities and expressions, and generally creating safe spaces for trans patients to be themselves.…”