Adherence to Antiretroviral Therapy Among Transgender and Gender Nonconforming People Living with HIV: Findings from the 2015 U.S. Trans Survey

Abstract

Purpose: This article includes an analysis of medication adherence among transgender and gender nonconforming (TGNC) people living with HIV (PLWH) from the 2015 U.S. Trans Survey (USTS), the largest survey of TGNC people in the United States. Methods: Using data from the USTS, our analytic sample included 162 TGNC PLWH who had been prescribed antiretroviral (ART). We grouped respondents by adherent/nonadherent and compared demographic characteristics and potential adherence risk factors.Results: Approximately 65.8% of participants reported ''taking ART as prescribed'' all the time (61.0% trans women and 85.7% of trans men). Black TGNC PLWH were more likely to be nonadherent than whites or Hispanics. Adherent participants reported higher rates of home ownership. Nonadherent PLWH reported higher rates of verbal harassment, sex work, and homelessness in the past year, and lower rates of visiting an HIV doctor for care in the past year. Conclusions: USTS respondents living with HIV reported lower adherence than in other nationally representative studies of this population in medical care. HIV rates are higher among black individuals, and reported adherence is lower, suggesting this is a high-priority population. Findings also suggest that unstable sociostructural conditions (homelessness, sex work, etc.) compromise medication adherence. Future practice directions include integrating HIV treatment plans into larger support services for TGNC PLWH.

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“…Issues of concern identified in one study include those associated with poor mental health, substance use, violence, lack of family support, homelessness, and unemployment, all of which can compromise the ability to achieve a suppressed viral load. 47 …”

Characterizing Disparities in the HIV Care Continuum among Transgender and Cisgender Medicare Beneficiaries

“…In studies using convenience samples and multi-center cohorts, TGD people have been less likely to be adherent to ART than cisgender people [13][14][15]43]. TGD people with HIV have been shown to face barriers to ART adherence, with studies finding that low levels of social support [13], housing instability, and sex work are associated with lower adherence for some TGD populations [44].…”

Pharmacotherapy considerations in transgender individuals living with human immunodeficiency virus

“…In fact, initiation or continuation of hormone therapy in concert with ART may improve engagement and retention in HIV care along with ART adherence and achievement of viral suppression 19–21 . In an analysis of survey responses from the 2015 U.S. Transgender Survey (USTS) evaluating medication adherence among transgender and gender‐nonconforming PLWH reported that 65.8% of respondents took ART as prescribed (61% transfeminine individuals and 85.7% transmasculine individuals) 22 . Individuals reporting nonadherence to ART reported higher rates of verbal harassment, sex work, homelessness in the last year, and lower rates of engagement in medical care for HIV 22 .…”

“…In an analysis of survey responses from the 2015 U.S. Transgender Survey (USTS) evaluating medication adherence among transgender and gender‐nonconforming PLWH reported that 65.8% of respondents took ART as prescribed (61% transfeminine individuals and 85.7% transmasculine individuals) 22 . Individuals reporting nonadherence to ART reported higher rates of verbal harassment, sex work, homelessness in the last year, and lower rates of engagement in medical care for HIV 22 . Targeted interventions to improve ART medication adherence in this population should occur in individuals under the age of 40 years, of Black ethnicity, with unstable sociostructural conditions (i.e.…”