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Effect of Legal Status on the Early Treatment Outcomes of Migrants Beginning Combined Antiretroviral Therapy at an Outpatient Clinic in Milan, Italy. J Acquir Immune Defic Syndr 2017; 75:315-321. [PMID: 28418991 DOI: 10.1097/qai.0000000000001388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In a setting of free access to HIV care, we compared the early treatment outcomes of HIV-infected undocumented migrants (UMs), documented migrants (DMs), and Italian subjects. METHODS The clinical data of 640 Italians and 245 migrants who started combined antiretroviral therapy (cART) at an HIV clinic in Milan, Italy, were reviewed. The migrants were mainly Latin Americans (83 DMs and 56 UMs) or sub-Saharan Africans (52 DMs and 11 UMs), but a minority were of other origin (33 DMs and 10 UMs). Retention in follow-up and HIV suppression were compared between UMs, DMs, and natives 12 months ± 90 days after start of cART. RESULTS There were no significant between-group differences in the stage of HIV infection at the start of cART or the type of regimen received. The Latin American DMs and UMs included a higher proportion of transgender women than the other ethnic groups (P < 0.001). The UMs were less frequently followed up after 12 months than the DMs and natives (P = 0.004) and were more frequently permanently lost to follow-up (P < 0.001). UM status was an independent predictor of lost to follow-up (adjusted odds ratio 8.05, P < 0.001). The DMs and UMs were less frequently HIV suppressed after 12 months than the natives (78% and 80.7% vs 90.5%, P = 0.001), and Latin American migrants were significantly less likely to be virologically suppressed than the natives (adjusted odds ratio 0.30, P = 0.001). CONCLUSIONS Despite their free access to cART, subgroups of migrants facing multiple levels of vulnerability still have difficulties in gaining optimal HIV care.
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Braun HM, Candelario J, Hanlon CL, Segura ER, Clark JL, Currier JS, Lake JE. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health 2017; 4:371-375. [PMID: 28876170 DOI: 10.1089/lgbt.2017.0057] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Both hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence. METHODS This study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA. RESULTS Fifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns. CONCLUSION Imperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.
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Affiliation(s)
- Hannan M Braun
- 1 School of Medicine, University of California , San Francisco, San Francisco, California.,2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jury Candelario
- 3 APAIT, Special Service for Groups , Los Angeles, California
| | - Courtney L Hanlon
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Eddy R Segura
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,5 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima, Peru
| | - Jesse L Clark
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Judith S Currier
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jordan E Lake
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,6 Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston , Houston, Texas
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53
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Behavioral Interventions to Prevent HIV Transmission and Acquisition for Transgender Women: A Critical Review. J Acquir Immune Defic Syndr 2017; 72 Suppl 3:S220-5. [PMID: 27429186 PMCID: PMC4969058 DOI: 10.1097/qai.0000000000001084] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Worldwide, transgender women are at disproportionately higher risk of HIV infection, with the primary mode of infection being condomless anal intercourse. Although very few HIV prevention interventions have been developed and tested specifically for transgender women, growing evidence suggests that behavioral HIV risk reduction interventions for other marginalized groups are efficacious. We outline the current state of knowledge and areas in need of further development in this area.
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Abstract
Transgender (trans) communities worldwide, particularly those on the trans feminine spectrum, are disproportionately burdened by HIV infection and at risk for HIV acquisition/transmission. Trans individuals represent an underserved, highly stigmatized, and under-resourced population not only in HIV prevention efforts but also in delivery of general primary medical and clinical care that is gender affirming. We offer a model of gender-affirmative integrated clinical care and community research to address and intervene on disparities in HIV infection for transgender people. We define trans terminology, briefly review the social epidemiology of HIV infection among trans individuals, highlight gender affirmation as a key social determinant of health, describe exemplar models of gender-affirmative clinical care in Boston MA, New York, NY, and San Francisco, CA, and offer suggested “best practices” for how to integrate clinical care and research for the field of HIV prevention. Holistic and culturally responsive HIV prevention interventions must be grounded in the lived realities the trans community faces to reduce disparities in HIV infection. HIV prevention interventions will be most effective if they use a structural approach and integrate primary concerns of transgender people (eg, gender-affirmative care and management of gender transition) alongside delivery of HIV-related services (eg, biobehavioral prevention, HIV testing, linkage to care, and treatment).
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55
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High Frequency of Illegal Drug Use Influences Condom Use Among Female Transgender Sex Workers in Argentina: Impact on HIV and Syphilis Infections. AIDS Behav 2017; 21:2059-2068. [PMID: 28424971 DOI: 10.1007/s10461-017-1766-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The high prevalence of HIV and syphilis found among female transgender sex workers (FTSWs) in Argentina calls for the study of factors leading to negative health consequences. Given the particular characteristics observed in this population (high marginalization, school dropout, and low adherence to healthcare services), we explored the association of several socio-demographic characteristics with syphilis and HIV infections, and the determinants of condom use. This study revealed that FTSWs from Argentina were exposed to several risk factors decreasing thus their ability to negotiate condom use and leading to increased risk for transmission of HIV and other sexually transmitted infections (STIs). Strategies to reduce HIV and syphilis in this population should consider interventions aimed at decreasing violence and substance use which appear to be the most important determinants. Results of this study will contribute to the global information among FTSWs.
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Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Facilitators and Barriers to Participation in PrEP HIV Prevention Trials Involving Transgender Male and Female Adolescents and Emerging Adults. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:205-217. [PMID: 28650227 PMCID: PMC5768197 DOI: 10.1521/aeap.2017.29.3.205] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Despite the disproportionate burden of HIV facing transgender youth, they continue to be under-represented in studies to provide an empirical basis for pre-exposure prophylaxis (PrEP) programs that can meet the unique needs of this population. This study examined facilitators and barriers to participation in a PrEP adherence study, determined through an online survey administered to 90 transgender male and 60 transgender female 14-21-year-olds attracted to cisgender male sexual partners. Approximately 50% reported likely to participate in the PrEP study. Participation facilitators included prior sexual and health service experiences and study access to PrEP and health services. Participation barriers included lack of concern about HIV, potential medication side effects, the logistics of quarterly meetings, remembering to take PrEP daily, and reluctance to discuss gender identity with study staff. Results suggest that successful recruitment and retention of transgender youth in PrEP prevention studies warrant protocols designed to address these barriers.
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Affiliation(s)
- Celia B Fisher
- Fordham University Center for Ethics Education, Bronx, New York
| | - Adam L Fried
- Fordham University Center for Ethics Education, Bronx, New York
| | | | - Kathryn Macapagal
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Brian Mustanski
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Mizuno Y, Beer L, Huang P, Frazier EL. Factors Associated with Antiretroviral Therapy Adherence Among Transgender Women Receiving HIV Medical Care in the United States. LGBT Health 2017; 4:181-187. [PMID: 28498011 DOI: 10.1089/lgbt.2017.0003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We examined factors associated with antiretroviral therapy (ART) adherence among transgender women living with HIV (TWLWH). METHODS We used combined data from the 2009 to 2013 cycles of Medical Monitoring Project, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving HIV medical care in the United States. Rao-Scott chi-square tests and multivariable logistic regression were used to identify factors associated with dose adherence (defined as taking 100% of prescribed ART doses in the past 3 days). RESULTS Among TWLWH who reported current ART use, an estimated 80.5% self-reported dose adherence. Multivariable factors independently associated with lower (<100%) dose adherence were younger age (30-39 vs. 40 and over), not having health insurance coverage, depression, lower self-efficacy to take medication as prescribed, and having greater than one daily ART dose. CONCLUSION Our findings suggest several ways to potentially improve ART adherence of TWLWH including tailoring efforts to address the needs of TWLWH under age 40, increasing access to health insurance coverage, addressing mental health morbidities, building skills to improve medication adherence self-efficacy, and simplifying ART regimens when possible.
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Affiliation(s)
- Yuko Mizuno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Ping Huang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Emma L Frazier
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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Abstracts of the HIV & Hepatitis in the Americas 2017 - Congress. J Int AIDS Soc 2017; 20:21954. [PMID: 28440071 PMCID: PMC5625637 DOI: 10.7448/ias.20.3.21954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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59
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Beckwith C, Castonguay BU, Trezza C, Bazerman L, Patrick R, Cates A, Olsen H, Kurth A, Liu T, Peterson J, Kuo I. Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study. PLoS One 2017; 12:e0169078. [PMID: 28081178 PMCID: PMC5231337 DOI: 10.1371/journal.pone.0169078] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender. Methods We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender. Results Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05). Conclusions In this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes. Trial registration Registered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.
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Affiliation(s)
- Curt Beckwith
- The Miriam Hospital, Providence, RI, United States of America.,Brown University Alpert School of Medicine, Providence, RI, United States of America
| | - Breana Uhrig Castonguay
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Claudia Trezza
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Lauri Bazerman
- The Miriam Hospital, Providence, RI, United States of America
| | - Rudy Patrick
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Alice Cates
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Halli Olsen
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Ann Kurth
- Yale University School of Nursing, New Haven, CT, United States of America
| | - Tao Liu
- Brown University School of Public Health, Providence, RI, United States of America
| | - James Peterson
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
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Lacombe-Duncan A. An Intersectional Perspective on Access to HIV-Related Healthcare for Transgender Women. Transgend Health 2016; 1:137-141. [PMID: 29159304 PMCID: PMC5685282 DOI: 10.1089/trgh.2016.0018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Transgender women experience decreased access to HIV-related healthcare relative to cisgender people, in part due to pervasive transphobia in healthcare. This perspective describes intersectionality as a salient theoretical approach to understanding this disparity, moving beyond transphobia to explore how intersecting systems of oppression, including cisnormativity, sexism/transmisogyny, classism, racism, and HIV-related, gender nonconformity, substance use, and sex work stigma influence HIV-related healthcare access for transgender women living with HIV. This perspective concludes with a discussion of how intersectionality-informed studies can be enhanced through studying underexplored intersections and bringing attention to women's resiliency and empowerment.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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61
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Sevelius JM, Keatley J, Calma N, Arnold E. 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health 2016; 11:1060-75. [PMID: 26963756 DOI: 10.1080/17441692.2016.1154085] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The frequent conflation of transgender ('trans') women with 'men who have sex with men (MSM)' in HIV prevention obscures trans women's unique gender identities, social and behavioural vulnerabilities, and their disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an efficacious biomedical HIV prevention approach. However, trans women are underrepresented in PrEP research, and are often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined PrEP acceptability among trans women via three focus groups and nine individual interviews (total N = 30) in San Francisco. While knowledge of PrEP was low, interest was relatively high once participants were informed. Due to past negative healthcare experiences, ability to obtain PrEP from a trans-competent provider was cited as essential to PrEP uptake and adherence. Participants noted that PrEP could address situations in which trans women experience reduced power to negotiate safer sex, including sex work. Trans-specific barriers included lack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia. Findings underscore the importance of disaggregating trans women from MSM in HIV prevention strategies to mitigate disparate risk among this highly vulnerable population.
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Affiliation(s)
- Jae M Sevelius
- a Department of Family & Community Medicine , Center of Excellence for Transgender Health, University of California , San Francisco , CA , USA.,b Department of Medicine , Center for AIDS Prevention Studies, University of California , San Francisco , CA , USA
| | - JoAnne Keatley
- a Department of Family & Community Medicine , Center of Excellence for Transgender Health, University of California , San Francisco , CA , USA
| | - Nikki Calma
- c Trans Thrive Program, Asian & Pacific Islander Wellness Center , San Francisco , CA , USA
| | - Emily Arnold
- b Department of Medicine , Center for AIDS Prevention Studies, University of California , San Francisco , CA , USA
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62
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Abstract
Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies.
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Affiliation(s)
- Glenda N Baguso
- a Department of Community Health Systems , University of California , San Francisco , CA , USA
| | - Caryl L Gay
- b Department of Family Health Care Nursing , University of California , San Francisco , CA , USA
| | - Kathryn A Lee
- b Department of Family Health Care Nursing , University of California , San Francisco , CA , USA
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Escudero DJ, Kerr T, Operario D, Socías ME, Sued O, Marshall BDL. Inclusion of trans women in pre-exposure prophylaxis trials: a review. AIDS Care 2014; 27:637-41. [PMID: 25430940 DOI: 10.1080/09540121.2014.986051] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Trans women are at high risk of HIV infection. We conducted a review to determine the extent to which trans women were eligible for inclusion in and enrolled into pre-exposure prophylaxis (PrEP) efficacy trials. Out of seven trials analyzing PrEP efficacy, we found that trans women comprised only 1.2% of one trial and 0.2% of total trial enrollments. Although an additional PrEP trial to determine efficacy among trans women may not be warranted, further research is needed to determine the effectiveness of PrEP in this marginalized population, through observational and feasibility studies. These studies should focus on unique barriers that trans women may experience while obtaining access to PrEP, such as gender discrimination, transphobia, and violence.
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Affiliation(s)
- Daniel J Escudero
- a Department of Epidemiology, School of Public Health , Brown University , Providence , RI , USA
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