Access to HIV Care and Support Services for African American Transwomen Living with HIV

Wilson, Erin C.; Arayasirikul, Sean; Johnson, Kent C.

doi:10.1080/15532739.2014.890090

Cited by 59 publications

(64 citation statements)

References 24 publications

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“…However, few (12%) transwomen in our study had access to trans-specific healthcare, and it is known that transwomen have significant challenges to accessing primary and HIV medical care, even where it is available [13,17,18]. Additionally, studies of transwomen living with HIV in the USA and Canada identified fear of disclosure of transgender identity, poor treatment by staff, and providers’ lack of awareness of transgender issues, as important barriers to engagement in care [19,20].…”

Section: Discussionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

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Introduction: Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population-level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil. Methods: We conducted a respondent-driven sampling (RDS) study of transwomen from August 2015 to January 2016 in Rio de Janeiro, Brazil and collected data on linkage and access to care, antiretroviral treatment and performed HIV viral load testing. We derived population-based estimates of cascade indicators using sampling weights and conducted RDS-weighted logistic regression analyses to evaluate correlates of viral suppression (viral load ≤50 copies/mL). Results: Of the 345 transwomen included in the study, 89.2% (95% CI 55–100%) had been previously tested for HIV, 77.5% (95% CI 48.7–100%) had been previously diagnosed with HIV, 67.2% (95% CI 39.2–95.2) reported linkage to care, 62.2% (95% CI 35.4–88.9) were currently on ART and 35.4% (95% CI 9.5–61.4%) had an undetectable viral load. The final adjusted RDS-weighted logistic regression model for viral suppression indicated that those who self-identified as black (adjusted odds ratio [aOR] 0.06, 95% CI 0.01–0.53, p < 0.01), reported earning ≤U$160/month (aOR 0.11, 95% CI 0.16–0.87, p = 0.04) or reported unstable housing (aOR 0.08, 95% CI 0.01–0.43, p < 0.01) had significantly lower odds of viral suppression. Conclusions: Our cascade indicators for transwomen showed modest ART use and low viral suppression rates. Multi-level efforts including gender affirming care provision are urgently needed to decrease disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.

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Section: Discussionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

Self Cite

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“…Other research experiences and input from community partners suggested that among some communities of color, transgender persons do not often socialize and interact with gay, bisexual, and other MSM, and thus it would not be possible to create an intervention that brings these communities together (Wilson, Arayasirikul, & Johnson, 2013). However, in this analysis, we found the opposite to be true; most events with transgender persons in attendance were hosted by the gay-identified male Navegantes.…”

Section: Discussionmentioning

confidence: 99%

Latino Sexual and Gender Identity Minorities Promoting Sexual Health Within Their Social Networks

Sun

García

Mann

et al. 2014

Health Promotion Practice

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The HOLA intervention was a lay health advisor intervention designed to reduce the disproportionate HIV burden borne by Latino sexual and gender identity minorities (gay, bisexual, and other men who have sex with men, and transgender persons) living in the United States. Process evaluation data were collected for over a year of intervention implementation from 11 trained Latino male and transgender lay health advisors (Navegantes) to document the activities each Navegante conducted to promote condom use and HIV testing among his or her 8 social network members enrolled in the study. Over 13 months, the Navegantes reported conducting 1,820 activities. The most common activity was condom distribution. Navegantes had extensive reach beyond their enrolled social network members, and they engaged in health promotion activities beyond social network members enrolled in the study. There were significant differences between the types of activities conducted by Navegantes depending on who was present. Results suggest that lay health advisor interventions reach large number of at-risk community members and may benefit populations disproportionately impacted by HIV.

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“…34 Transwomen who are in a racial/minority group may be even more reluctant to attempt to access to care because of racial discrimination on top of that related to transgender identity. 35 Interesting findings arose between transwomen who were living with HIV and those who were not. Both has high utilization of hormones, but transwomen living with HIV had less utilization of genital surgery and breast augmentation.…”

Section: Discussionmentioning

confidence: 99%

Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV

et al. 2014

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Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems-binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse-comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.

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Access to HIV Care and Support Services for African American Transwomen Living with HIV

Cited by 59 publications

References 24 publications

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Latino Sexual and Gender Identity Minorities Promoting Sexual Health Within Their Social Networks

Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV

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