HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study

Wirtz, Andrea L.; Humes, Elizabeth; Althoff, Keri N.; Poteat, Tonia; Radix, Asa; Mayer, Kenneth H.; Schneider, Jason; Haw, J. Sonya; Wawrzyniak, Andrew J.; Cannon, Christopher M.; Stevenson, Meg; Cooney, Erin E.; Adams, Dee; Case, James; Beyrer, Chris; Laeyendecker, Oliver; Rodríguez, Allan; Reisner, Sari L.

doi:10.1016/s2352-3018(23)00008-5

Cited by 20 publications

(18 citation statements)

References 26 publications

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“…The present study findings support prior work among cisgender sexual minority participants and research on mental health and HIV diagnosis among transgender people. However, there are limited data comparing the prevalence of cardiovascular disease, kidney disease, diabetes, and hypertension among transgender and gender diverse participants with cisgender populations.…”

Section: Discussionsupporting

confidence: 86%

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Tran,

Lunn,

Schulkey

et al. 2023

JAMA Netw Open

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ImportanceLimited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.ObjectiveTo evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.Design, Setting, and ParticipantsThis cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.ExposuresSelf-identified gender identity and sexual orientation group.Main Outcomes and MeasuresTwelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants’ physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group.ResultsThe analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups.Conclusions and RelevanceIn this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.

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Section: Discussionsupporting

confidence: 86%

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Tran,

Lunn,

Schulkey

et al. 2023

JAMA Netw Open

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“…In a large 2023 USA study focusing on indices of HIV risk among transgender women, unexpectedly high mortality was found. Although none of these deaths were HIV-related, the authors suggested that the issue is indicative of poor care and should not be neglected [ 97 ]. In terms of essential Pre-Exposure Prophylaxis (PrEP) medication for HIV prevention, another recent scoping review found high willingness (80%) to use PrEP among transgender women worldwide, yet low uptake and adherence (35.4%), with socioeconomic determinants, including poverty, substance use, stigma, and mistrust, again driving this phenomenon [ 98 ], in line with the barriers identified by this study.…”

Section: Discussionmentioning

confidence: 99%

Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece

Anastasaki,

Angelaki,

Paganis

et al. 2024

Healthcare

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Trans people face substantial barriers to care worldwide. In Greece, limited evidence regarding trans health and actions to improve accessibility in healthcare services is available. This study aims to identify barriers to care for transgender populations in order to discuss the potential gaps in healthcare providers’ training in this direction. A scoping review was conducted in PubMed. Study eligibility criteria included: (a) reporting on at least one barrier to care for trans individuals or at least one educational need for healthcare providers; (b) free full text availability; and (c) publishing from 2015 and afterwards. Discrepancies in study inclusion were discussed between the research team until consensus was reached. Out of 560 identified references, 69 were included in this study, with only three reporting empirical research from Greece. Several individual-, interpersonal-, and institutional-level barriers to healthcare for trans individuals were identified. These included discriminatory treatment by healthcare providers, a lack of knowledgeable providers trained on trans-specific healthcare issues, lack of trusted and safe healthcare environments, health coverage-related issues, and healthcare systems that do not take into account particular transgender health issues during care provision. Improving access to care for transgender people is a multidimensional issue that should be addressed at the societal, healthcare, and research levels. Actions for future professional education initiatives should focus on respecting transgender identity, protecting confidentiality, creating trusted provider–patient relationships, and providing sufficient competency on trans-specific healthcare issues.

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“…Furthermore, people who identify as transgender have higher rates of HIV (CDC, 2021b) and accessing gender-affirming care may serve as a route of engagement in preventive and HIV care (Van Gerwen & Blumenthal, 2023). Transwomen with access to gender affirming care are less likely to acquire HIV and are much less likely to die (Wirtz et al, 2023). Many programs and clinicians may offer to meet someone's gender affirming transition-related care priorities first and then integrate HIV prevention or treatment as they are ready (Van Gerwen & Blumenthal, 2023).…”

Section: Policies Influencing Public Health and Health Carementioning

confidence: 99%

Policy Challenges and Resiliency Related to Ending the HIV Epidemic in the Southern and Rural United States: A Call to Action

Moen,

Sublette,

Alves

et al. 2024

J Assoc Nurses AIDS Care

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In this commentary, we describe current policy trends and their implications for the health of populations in the Southern and rural United States. We outline policy changes that threaten the prevention, care, and treatment of people at risk for HIV or with HIV and sociopolitical factors contributing to these policy trends. We also issue a call-to-action for individuals with Southern and rural US policy expertise and lived or living experience to collaboratively engage on a systematic policy analysis to thoroughly document relevant policies and deepen our understanding of the influences behind these policies. Finally, we provide examples of individual, community, and national level resiliency and courage—strategies that inspire advocacy and hope in the face of policy setbacks.

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HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study

Cited by 20 publications

References 26 publications

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece

Policy Challenges and Resiliency Related to Ending the HIV Epidemic in the Southern and Rural United States: A Call to Action

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