Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

Abstract

In the U.S., transgender and other gender minority (TG) youth are an at-risk group understudied in HIV prevention and treatment. This study sought to characterize the HIV prevention and care continua in a diverse sample of 181 sexually-active TG ages 16–24 years (mean age = 20.7 years; 76.8% trans feminine; 69.1% youth of color) recruited July–December 2015 in 14 U.S. cities. Overall, 30.9% reported living with HIV, of which 71.4% were on antiretroviral therapy (ART) and 55.0% were medication adherent; 65.6% were known to be virally suppressed. In multivariable models, medical gender affirmation was associated with lower odds of viral suppression. Medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. Among at-risk TG youth not living with HIV, only 8.2% had accessed pre-exposure prophylaxis (PrEP). Early biobehavioral prevention and treatment interventions are needed for TG youth.

Successes and final challenges along the HIV care continuum with transwomen in San Francisco

“…The few studies we found indicated that transwomen have low HIV testing rates and low awareness of HIV status, low engagement and retention in HIV care, low medication adherence and low virologic suppression rates [4][5][6]. Suboptimal HIV engagement rates were found among transwomen from Brazil and US transgender youth [7,8]. African American transwomen were found to have even poorer reported viral suppression (24.5%) [9].…”

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

“…2,4,8,9 Such stigma and discrimination are associated with poor mental health, substance abuse, violence, lack of familial and social support, homelessness, and unemployment-all of which compromise HIV care. 2,9 Additional barriers include TGNC people's limited access to and engagement in medical care, including HIV care, [10][11][12] and lack of knowledge and sensitivity among health care providers to treat TGNC people and address their needs. 11,13 Advances in HIV treatment, however, have created opportunities for people living with HIV (PLWH) to live longer and healthier lives.…”

“…A few smaller community samples (N = 22 to N = 181) report lower ART adherence rates spanning from 55% to 68% among predominantly transgender women samples, although measurement of adherence varies across studies. 12,[16][17][18][19][20] Community studies of transgender populations report adherence barriers such as negative health care experiences 16 and transphobia. 12 The National HIV/AIDS Strategy for the United States calls for improving health outcomes and decreasing health disparities among transgender people.…”

“…12,[16][17][18][19][20] Community studies of transgender populations report adherence barriers such as negative health care experiences 16 and transphobia. 12 The National HIV/AIDS Strategy for the United States calls for improving health outcomes and decreasing health disparities among transgender people. 21 Meeting these goals necessitates better understanding of HIV adherence among this population, 18 although existing national community samples are few.…”

“…21 Meeting these goals necessitates better understanding of HIV adherence among this population, 18 although existing national community samples are few. 12 In this study we use the U.S. Transgender Survey (USTS) to explore factors associated with ART adherence among TGNC PLWH based on both the adherence literature and availability of variables in the USTS, including 22 demographics, health and health care indicators, substance use, and recent negative experiences of discrimination and sexual assault. 22…”