“I do the she and her”: A qualitative exploration of HIV care providers’ considerations of trans women in gender-specific HIV care

Abstract

Objectives: Women of all genders, including cisgender (cis) and transgender (trans) women, experience social and structural drivers of HIV inequities and pervasive barriers to HIV care. Yet, little is known about how HIV care providers address gender diversity in health care. Through a critical feminist lens informed by intersectionality theory, medical anthropology, and critical sociology, we explored (1) how do HIV care providers describe women living with HIV’s care needs and barriers; (2) what are their perspectives on optimal HIV care for women; and (3) to what extent do these conceptualizations include/exclude trans women. Methods: Utilizing a community-based exploratory qualitative study design, we conducted 60–90 minute semi-structured individual interviews from March 2019–April 2020 with eight HIV care providers ( n = 4 social service providers; n = 4 physicians) practicing across seven counties representative of rural, suburban, and urban Michigan, United States. Data were analyzed utilizing a reflexive thematic approach. Results: Three overarching themes emerged: (1) Emphasis on (different) clinical needs: key considerations in cis and trans women’s HIV care; (2) Recognition of the structural: barriers to HIV care affecting women of all genders; and (3) Proposed solutions: piecing together individual, social, and organizational interventions to increase access to HIV care that may benefit women living with HIV of all genders but are disproportionately framed as being for cis women. While HIV care providers recognized both cis and trans women living with HIV’s clinical care needs and structural barriers to care, they rarely envisioned optimal HIV care inclusive of gender affirmation and structural interventions. Conclusions: Findings suggest that HIV care providers can avoid reducing gender to biology and making assumptions about reproductive care needs, endocrinological care needs, caregiving responsibilities, and other life circumstances; provide gender-affirming medical care; and address structural barriers to HIV care to enhance intersectional and structurally focused gender-affirming—that is, trans-inclusive—women-centered HIV care.

Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) findings

“…The co-creation of separate composite concept maps for cis and trans women shows the important similarities and differences between cis and trans women’s experiences, and provides a unique perspective not explored in the individual concept maps. Our findings show many similarities in the health experiences of cis and trans women with HIV in CHIWOS were shared 21. This is important for providers who often assume providing care to trans women with HIV requires a unique skillset and approach 22.…”

“…Our findings show many similarities in the health experiences of cis and trans women with HIV in CHIWOS were shared. 21 This is important for providers who often assume providing care to trans women with HIV requires a unique skillset and approach. 22 The key differences in the summary diagrams were gender affirmation at the individual level, as well as trans care knowledge and training at the structural level.…”

Sex and single women in midlife: Theoretical perspectives, recent findings, and future directions

“…In stark contrast to affirmative aging narratives of sexual agency and positive sexual experiences revealed in the studies reviewed here, the sexual lives of these women have historically been portrayed as deviant or hypersexualized (e.g., Hodgson & McCurdy, 2001; Miller, 2019). Recent scholarship by Black, feminist, and queer folks has moved beyond a stigmatized, individual‐level risk behavior approach in illuminating the sexual lives of marginalized groups of women (e.g., Lacombe‐Duncan et al, 2022; Royles, 2020; Stevenson, 2022; Wade et al, 2022). For instance, in Remaking a Life , an ethnographic project on African American middle‐class and low‐income women living with HIV in Chicago, Watkins‐Hayes (2019) articulates not only the culmination of “injuries of inequalities,” documenting women's dynamic responses to social marginalization as they face the enduring effects of stressors, such as chronic unemployment and sexual trauma, but then also the affirmative experiences, such as economic wins and regained health.…”