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Fein LA, Barnett R, Liu T, Potter JE, Klatt NR, Alcaide ML, Jones DL. Gender Identity Stigma in Transgender Women Is Higher After Gender-Affirming Vaginoplasty. AIDS Res Hum Retroviruses 2024; 40:376-383. [PMID: 38084990 DOI: 10.1089/aid.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Gender affirmation may reduce stigma and gender-based discrimination that drive increased behaviors that can lead to HIV in transgender women (TW). For many TW, vaginoplasty is gender affirming, yet has not been previously evaluated with regard to likelihood of HIV. This pilot study of TW aimed to evaluate the influence of gender-affirming vaginoplasty on stigma and the drivers of HIV acquisition. Adult TW without HIV were recruited. Interviewer-administered surveys were used to assess demographics, gender identity stigma, psychosocial factors, importance of and satisfaction with gender affirmation, and behaviors that increase the likelihood of HIV in TW who had either undergone gender-affirming vaginoplasty (TWWV) or who had not (TWWOV). Statistical analysis was conducted using descriptive statistics, Fisher's exact tests, and Wilcoxon rank-sum tests. Thirty TW without HIV (19-83 years old) participated (TWWV = 10; TWWOV = 20). The majority identified with ethnic minority groups (n = 21, 70%) and on gender-affirming hormone therapy (n = 25, 83%). Gender identity stigma (38.0; 32.15, p = .03) and social oppression (53.6; 39.4, p = .05) scores were significantly higher among TWWV compared with TWWOV. Satisfaction with body (3.10; 1.95, p = .01), appearance (3.10; 2.10, p = .02), and femininity (3.40; 2.25, p = .001) were higher among TWWV than TWWOV. Present (n = 8, 27%) and past (n = 16, 53%) survival sex work, multiple sex partners (n = 16, 53%), and receptive condomless anal intercourse (n = 10, 33%) were reported but did not vary significantly between groups. Behaviors that may lead to HIV acquisition and their underlying drivers, including gender identity stigma, are present after gender-affirming vaginoplasty. As this procedure continues to increase among TW, interventions to mitigate chances of HIV acquisition are critically needed in this population.
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Affiliation(s)
- Lydia A Fein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rebecca Barnett
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tianhao Liu
- Division of Biostatistics, Department of Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - JoNell E Potter
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nichole R Klatt
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria L Alcaide
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024. [PMID: 38753455 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Hughto JM, Varma H, Yee K, Babbs G, Hughes LD, Pletta DR, Meyers DJ, Shireman TI. Characterizing Disparities in the HIV Care Continuum among Transgender and Cisgender Medicare Beneficiaries. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.19.24304525. [PMID: 38562705 PMCID: PMC10984057 DOI: 10.1101/2024.03.19.24304525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background In the US, transgender and gender-diverse (TGD) individuals, particularly trans feminine individuals, experience a disproportionately high burden of HIV relative to their cisgender counterparts. While engagement in the HIV Care Continuum (e.g., HIV care visits, antiretroviral (ART) prescribed, ART adherence) is essential to reduce viral load, HIV transmission, and related morbidity, the extent to which TGD people engage in one or more steps of the HIV Care Continuum at similar levels as cisgender people is understudied on a national level and by gendered subgroups. Methods and Findings We used Medicare Fee-for-Service claims data from 2009 to 2017 to identify TGD (trans feminine and non-binary (TFN), trans masculine and non-binary (TMN), unclassified gender) and cisgender (male, female) beneficiaries with HIV. Using a retrospective cross-sectional design, we explored within- and between-gender group differences in the predicted probability (PP) of engaging in one or more steps of the HIV Care Continuum. TGD individuals had a higher predicted probability of every HIV Care Continuum outcome compared to cisgender individuals [HIV Care Visits: TGD PP=0.22, 95% Confidence Intervals (CI)=0.22-0.24; cisgender PP=0.21, 95% CI=0.21-0.22); Sexually Transmitted Infection (STI) Screening (TGD PP=0.12, 95% CI=0.11-0.12; cisgender PP=0.09, 95% CI=0.09-0.10); ART Prescribed (TGD PP=0.61, 95% CI=0.59-0.63; cisgender PP=0.52, 95% CI=0.52-0.54); and ART Persistence or adherence (90% persistence: TGD PP=0.27, 95% CI=0.25-0.28; 95% persistence: TGD PP=0.13, 95% CI=0.12-0.14; 90% persistence: cisgender PP=0.23, 95% CI=0.22-0.23; 95% persistence: cisgender PP=0.11, 95% CI=0.11-0.12)]. Notably, TFN individuals had the highest probability of every outcome (HIV Care Visits PP =0.25, 95% CI=0.24-0.27; STI Screening PP =0.22, 95% CI=0.21-0.24; ART Prescribed PP=0.71, 95% CI=0.69-0.74; 90% ART Persistence PP=0.30, 95% CI=0.28-0.32; 95% ART Persistence PP=0.15, 95% CI=0.14-0.16) and TMN people or cisgender females had the lowest probability of every outcome (HIV Care Visits: TMN PP =0.18, 95% CI=0.14-0.22; STI Screening: Cisgender Female PP =0.11, 95% CI=0.11-0.12; ART Receipt: Cisgender Female PP=0.40, 95% CI=0.39-0.42; 90% ART Persistence: TMN PP=0.15, 95% CI=0.11-0.20; 95% ART Persistence: TMN PP=0.07, 95% CI=0.04-0.10). The main limitation of this research is that TGD and cisgender beneficiaries were included based on their observed care, whereas individuals who did not access relevant care through Fee-for-Service Medicare at any point during the study period were not included. Thus, our findings may not be generalizable to all TGD and cisgender individuals with HIV, including those with Medicare Advantage or other types of insurance. Conclusions Although TGD beneficiaries living with HIV had superior engagement in the HIV Care Continuum than cisgender individuals, findings highlight notable disparities in engagement for TMN individuals and cisgender females, and engagement was still low for all Medicare beneficiaries, independent of gender. Interventions are needed to reduce barriers to HIV care engagement for all Medicare beneficiaries to improve treatment outcomes and reduce HIV-related morbidity and mortality in the US.
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Affiliation(s)
- Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Hiren Varma
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Kim Yee
- OHSU-PSU School of Public Health, Portland, OR, United States
| | - Gray Babbs
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Landon D. Hughes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - David R. Pletta
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
| | - David J. Meyers
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Theresa I. Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Baugher AR, Olansky E, Sutter L, Cha S, Lewis R, Morris E, Agnew-Brune C, Trujillo L, Respress E, Lee K. Prevalence of Discrimination and the Association Between Employment Discrimination and Health Care Access and Use - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:51-60. [PMID: 38261571 PMCID: PMC10826684 DOI: 10.15585/mmwr.su7301a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Transgender women experience discrimination in many settings, including in employment. Because employment and health insurance are intertwined in the United States, employment discrimination might be related to lower health insurance coverage and health care use, including gender-affirming care. This analysis used data from transgender women (N = 1,608) in seven urban areas in the United States collected during 2019-2020 to present the prevalence of six discrimination types (employment, housing, bathroom, businesses, health care, and abuse) and to measure the association between employment discrimination (defined as trouble getting a job or fired due to being transgender) and sociodemographic characteristics, health care access, and health care use. Log-linked Poisson regression models were conducted to estimate adjusted prevalence ratios and 95% CIs. Seven in 10 transgender women experienced at least one type of discrimination during the past 12 months. During the same period, 9.9% of transgender women were fired and 32.4% had trouble getting a job because of being transgender. Employment discrimination was associated with younger age and lower socioeconomic status. Having trouble getting a job was associated with health care access and health care use factors, including having no health insurance or having Medicaid only, having an unmet medical need because of cost, never having transgender-specific care, and having an unmet need for gender-affirming procedures. These findings suggest that employment discrimination contributes to transgender women's economic marginalization and their ability to obtain adequate health insurance coverage and achieve their transition goals. These findings might help guide efforts that protect transgender women's right to pursue their work, health, and life goals without discrimination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland; ICF, Fairfax, Virginia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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Storholm ED, Ogunbajo A, Nacht CL, Opalo C, Horvath KJ, Lyman P, Flynn R, Reback CJ, Blumenthal J, Moore DJ, Bolan R, Morris S. Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California. Behav Med 2024; 50:63-74. [PMID: 35993278 PMCID: PMC9943802 DOI: 10.1080/08964289.2022.2105794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University
- RAND Corporation
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
| | - Adedotun Ogunbajo
- RAND Corporation
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | | | | | | | | | | | - Cathy J. Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
- Friends Research Institute
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine
| | - David J. Moore
- AntiViral Research Center, University of California, San Diego School of Medicine
| | | | - Sheldon Morris
- AntiViral Research Center, University of California, San Diego School of Medicine
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7
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Cannon SM, Smith LR, Jacobsen DM, Valderama MT, Silva J, Blumenthal J. Assessing Knowledge of, Experience with, and Willingness to Prescribe Hormone Therapy to Transgender Individuals with HIV: A National Survey of HIV Practitioners. Transgend Health 2023; 8:534-541. [PMID: 38130987 PMCID: PMC10732173 DOI: 10.1089/trgh.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to determine if human immunodeficiency virus (HIV) practitioners offer gender-affirming hormone therapy (GAHT) to their transgender patients living with HIV, as previous studies have shown that these patients are more likely to be virally suppressed and retained in care. Methods We conducted an online survey sent to 2570 HIV practitioners who attended an International Antiviral Society-USA event between 2017 and 2019. We also assessed demographics, transgender care training, comfort, prescribing practices, and knowledge. Results Respondents (N=385) were mainly primary care (49%) and infectious disease (ID)/HIV (42%) practitioners. Fifty-seven percent prescribed GAHT to transgender people living with HIV, but only 7% received formal training. Thirty-five percent were ID/HIV, 60% were primary care, and 5% were other specialty practitioners. Most felt that it would be beneficial to have formal education in GAHT practices during training (83%). There were statistically significant differences in GAHT education, experiences, knowledge, and interest in future training and prescribing by health care specialty. Commonly cited barriers to providing therapy included lack of training (33%), lack of transgender people living with HIV in practice (18%), and lack of qualified mental health professionals (15%). Conclusion This survey is the first to assess GAHT practices among HIV practitioners from across the United States. The majority of those surveyed prescribe GAHT to their transgender patients living with HIV. Although most felt comfortable doing so, few had formal training and knowledge scores were low. We advocate for the integration of GAHT education into formal training programs and offer resources for those who wish to pursue education.
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Affiliation(s)
- Sophie M. Cannon
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA
| | | | | | - Jordan Silva
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA
| | - Jill Blumenthal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA
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Van Gerwen OT, Blumenthal JS. Providing gender-affirming care to transgender and gender-diverse individuals with and at risk for HIV. TOPICS IN ANTIVIRAL MEDICINE 2023; 31:3-13. [PMID: 37018731 PMCID: PMC10089290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Transgender and gender-diverse populations have unique medical and psychosocial needs. It is important that clinicians address these needs with a gender-affirming approach in all aspects of health care for these populations. Given the significant burden of HIV experienced by transgender people, such approaches in providing HIV care and prevention are essential both to engage this population in care and to work toward ending the HIV epidemic. This review presents a framework for practitioners caring for transgender and gender-diverse individuals to deliver affirming, respectful health care in HIV treatment and prevention settings.
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Frola CE, Aristegui I, Figueroa MI, Radusky PD, Cardozo N, Zalazar V, Cesar C, Patterson P, Fink V, Gun A, Cahn P, Sued O. Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study. PLoS One 2023; 18:e0279996. [PMID: 36662723 PMCID: PMC9858466 DOI: 10.1371/journal.pone.0279996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023] Open
Abstract
In Argentina, transgender women (TGW) have a high HIV prevalence (34%). However, this population shows lower levels of adherence, retention in HIV care and viral suppression than cisgender patients. The World Health Organization (WHO) recommends the transition to dolutegravir (DTG)-based regimens to reduce adverse events and improve adherence and retention. The purpose of this study was to determine retention, adherence and viral suppression in naïve TGW starting a DTG-based first-line antiretroviral treatment (ART) and to identify clinical and psychosocial factors associated with retention. We designed a prospective, open-label, single-arm trial among ART-naïve HIV positive TGW (Clinical Trial Number: NCT03033836). Participants were followed at weeks 4, 8, 12, 24, 36 and 48, in a trans-affirmative HIV care service that included peer navigators, between December, 2015 and May, 2019. Retention was defined as the proportion of TGW retained at week 48 and adherence was self-reported. Viral suppression at <50 copies/mL was evaluated using snapshot algorithm and as per protocol analysis. Of 75 TGW screened, 61 were enrolled. At baseline, median age was 28 y/o., HIV-1-RNA (pVL) 46,908 copies/mL and CD4+ T-cell count 383 cells/mm3. At week 48, 77% were retained and 72% had viral suppression (97% per protocol). The regimen was well tolerated and participants reported high adherence (about 95%). Eleven of the fourteen TGW who discontinued or were lost to follow-up had undetectable pVL at their last visit. Older age was associated with better retention. DTG-based treatment delivered by a trans-competent team in a trans-affirmative service was safe and well tolerated by TGW and associated with high retention, high adherence and high viral suppression at 48 weeks among those being retained.
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Affiliation(s)
- Claudia E. Frola
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Division of Infectious Diseases, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | | | - Pablo D. Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | | | - Carina Cesar
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | - Valeria Fink
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ana Gun
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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10
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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11
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Chyten-Brennan J, Patel VV, Anastos K, Hanna DB. Brief Report: Role of Gender-Affirming Hormonal Care in HIV Care Continuum Outcomes When Comparing Transgender Women With Cisgender Sexual Minority Men. J Acquir Immune Defic Syndr 2022; 91:255-260. [PMID: 36252240 PMCID: PMC9577885 DOI: 10.1097/qai.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women (transwomen) are frequently conflated with cisgender sexual minority men (cis-SMM) in HIV research. We examined the impact of socioeconomic and health conditions, and gender-affirming hormones in comparing HIV-related outcomes between cis-SMM and transwomen. SETTING Large tertiary care health system in the Bronx, NY. METHODS Retrospective cohort study of people with HIV receiving care in 2008-2017. We compared retention in care, antiretroviral therapy (ART) prescription, and viral suppression between cis-SMM and transwomen, using modified Poisson regression, adjusting for demographic and clinical factors. Transwomen were further stratified by receipt of estrogen prescription. RESULTS We included 166 transwomen (1.4%), 1936 cis-SMM (17%), 4715 other cisgender men (41%), and 4745 cisgender women (41%). Transwomen were more likely to have public insurance (78% vs 65%) and mental health (49% vs 39%) or substance use (43% vs 33%) diagnoses than cis-SMM. Compared with cis-SMM, transwomen prescribed estrogen (67% of transwomen) were more likely to be retained [adjusted risk ratio (aRR) 1.15, 95% confidence interval (CI) 1.08 to 1.23), prescribed ART (aRR 1.06, CI 1.01 to 1.11), and virally suppressed (aRR 1.08, CI 1.01 to 1.16). Transwomen not prescribed estrogen were less likely to be retained (aRR 0.92, CI 0.83 to 1.02), prescribed ART (aRR 0.90, CI 0.82 to 0.98), or virally suppressed (aRR 0.85, CI 0.76 to 0.95). CONCLUSIONS In the context of HIV, socioeconomic factors, comorbidities, and gender-affirming care distinguish transwomen from cis-SMM. Compared with cis-SMM, transwomen who were prescribed estrogen had better HIV care continuum outcomes; transwomen not prescribed estrogen had worse outcomes. These differences should be accounted for in HIV-related research.
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Affiliation(s)
- Jules Chyten-Brennan
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
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12
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Sevelius JM, Dilworth SE, Reback CJ, Chakravarty D, Castro D, Johnson MO, McCree B, Jackson A, Mata RP, Neilands TB. Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV. J Acquir Immune Defic Syndr 2022; 90:508-516. [PMID: 35502891 PMCID: PMC9259040 DOI: 10.1097/qai.0000000000003014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health. SETTING/METHODS To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%. RESULTS We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points. CONCLUSIONS This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03081559.
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Affiliation(s)
- Jae M. Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Samantha E. Dilworth
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Cathy J. Reback
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Danielle Castro
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Breonna McCree
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Akira Jackson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Raymond P. Mata
- Friends Community Center, Friends Research Institute, Los Angeles, CA; and
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, Sangowawa O, Granger K, Dirisu O, Adedimeji AA. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc 2022; 25 Suppl 1:e25933. [PMID: 35818868 PMCID: PMC9274359 DOI: 10.1002/jia2.25933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Transgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria. METHODS In-depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services. RESULTS AND DISCUSSION Three main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender-inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender-inclusive and gender-affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender-inclusive CSO clinics. CONCLUSIONS This study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender-inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender-affirming HIV services.
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Affiliation(s)
- Waimar Tun
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Julie Pulerwitz
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | | | | | | | | | | | - Krista Granger
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Osasuyi Dirisu
- Policy Innovation Unit, Nigerian Economic Summit Group, Lagos, Nigeria
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14
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Radusky PD, Aristegui I, Mandell LN, Dell’Isola E, Zalazar V, Cardozo N, Alcaide ML, Weiss SM, Jones DL, Sued O. Examining Factors Associated with Gender Identity Among Individuals Disengaged from HIV Care in Argentina. Int J Behav Med 2022; 29:69-77. [PMID: 33954892 PMCID: PMC8901250 DOI: 10.1007/s12529-021-09998-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transgender women (TGW) consistently show lower adherence to antiretroviral treatment (ART), than cisgender people (CP) living with HIV. This study examined sociodemographic and psychosocial factors associated with gender identity among individuals disengaged from HIV care in Argentina. METHODS Data for this study was obtained at baseline from the Conexiones y Opciones Positivas en la Argentina 2 (COPA2) study. Forty-one TGW and 360 CP (177 male, 183 female) disengaged from HIV care completed questionnaires assessing sociodemographic information, severity of depressive symptoms, substance and alcohol use, patient-provider relationship quality, self-efficacy, ART adherence motivation, self-reported adherence, and treatment-related factors. Analyses included chi-square tests exploring the association between categorical variables and gender identity, and ANCOVAs comparing groups controlling for age. RESULTS Being a TGW was associated with having only public health insurance; substance use, particularly cocaine; substance-related problems; and hazardous drinking. TGW showed more negative consequences related to substance use, more hazardous alcohol use, lower patient-provider relationship quality, and lower self-reported adherence, than CP. CONCLUSIONS Harm reduction should be a key component in HIV care for TGW to address substance use. Health care teams should receive formal training in patient-provider communication skills and trans-specific competencies to enhance TGW's adherence and retention. Public policies to address structural factors that negatively affect TGW's adherence to ART are also needed.
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Affiliation(s)
- Pablo D. Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina,Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ines Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina,Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | - Lissa N. Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina,Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | - María L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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15
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Abebe W, Gebremariam M, Molla M, Teferra S, Wissow L, Ruff A. Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia. PLoS One 2022; 17:e0262638. [PMID: 35051244 PMCID: PMC8775187 DOI: 10.1371/journal.pone.0262638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Vertical transmission of HIV remains one of the most common transmission modes. Antiretroviral therapy (ART) decreases the risk of transmission to less than 2%, but maintaining adherence to treatment remains a challenge. Some of the commonly reported barriers to adherence to ART include stress (physical and emotional), depression, and alcohol and drug abuse. Integrating screening and treatment for psychological problem such as depression was reported to improve adherence. In this study, we sought to determine the prevalence of depression and its association with adherence to ART among HIV-positive pregnant women attending antenatal care (ANC) clinics in Addis Ababa, Ethiopia.
Methods
We conducted a cross-sectional survey from March through November 2018. Participants were conveniently sampled from 12 health institutions offering ANC services. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for depression and the Center for Adherence Support Evaluation (CASE) Adherence index to evaluate adherence to ART. Descriptive statistics was used to estimate the prevalence of depression during third-trimester pregnancy and nonadherence to ART. A bivariate logistic regression analysis was used to get significant predictors for each of the two outcome measures. The final multivariable logistic regression analysis included variables with a P<0.25 in the bivariate logistic regression model; statistical significance was evaluated at P<0.05.
Results
We approached 397 eligible individuals, of whom 368 (92.7%) participated and were included in the analysis. Of the total participants, 175(47.6%) had depression. The participants’ overall level of adherence to ART was 82%. Pregnant women with low income were twice more likely to have depression (AOR = 2.10, 95%CI = 1.31–3.36). Women with WHO clinical Stage 1 disease were less likely to have depression than women with more advanced disease (AOR = 0.16, 95%CI = 0.05–0.48). There was a statistically significant association between depression and nonadherence to ART (P = 0.020); nonadherence was nearly two times higher among participants with depression (AOR = 1.88, 95%CI = 1.08–3.27).
Conclusion
We found a high prevalence of depression among HIV-positive pregnant women in the selected health facilities in Addis Ababa, and what was more concerning was its association with higher rates of nonadherence to ART adversely affecting the outcome of their HIV care. We recommend integrating screening for depression in routine ANC services.
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Affiliation(s)
- Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mahlet Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Larry Wissow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Andrea Ruff
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
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16
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Labisi TO, Podany AT, Fadul NA, Coleman JD, King KM. Factors associated with viral suppression among cisgender women living with human immunodeficiency virus in the United States: An integrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221092267. [PMID: 35435055 PMCID: PMC9019389 DOI: 10.1177/17455057221092267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. OBJECTIVES This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. METHODS We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. RESULTS Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. CONCLUSION Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre-post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.
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Affiliation(s)
- Titilola O Labisi
- Department of Health Promotion and Disease Prevention, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony T Podany
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nada A Fadul
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jason D Coleman
- School of Health and Kinesiology, University of Nebraska Omaha, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion and Disease Prevention, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Summers NA, Huynh TT, Dunn RC, Cross SL, Fuchs CJ. Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women. Open Forum Infect Dis 2021; 8:ofab404. [PMID: 34514019 PMCID: PMC8415531 DOI: 10.1093/ofid/ofab404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023] Open
Abstract
Background Progression along the HIV care continuum has been a key focus for improving outcomes for people with HIV (PWH). Transgender women with HIV (TGWWH) have not made the same progress as their cisgender counterparts. Methods All PWH identifying as transgender women receiving care at our clinic from 1/1/2015 to 12/31/2019 were identified from the electronic health records (EHRs) using International Classification of Diseases (ICD) codes. Demographics, laboratory data, prescription of gender-affirming hormone therapy (GAHT), and visit history were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions. The proportions of TGWWH who were consistently retained in care or virally suppressed over time were calculated using a binary response generalized mixed model including random effects and correlated errors. Results Of the 76 PWH identified by ICD codes, 2 were excluded for identifying as cisgender and 15 for insufficient records, leaving 59 TGWWH included for analysis. Patients were on average 35 years old and Black (86%), with a median CD4 count of 464 cells/µL. There were 13 patients on GAHT at study entry and 31 receiving GAHT at any point during the study period. Fifty-five percent were virally suppressed at study entry and 86% at GAHT initiation. The proportion of TGWWH who were consistently virally suppressed over time was greater among those receiving GAHT compared with those who were not (P = .04). Conclusions Rates of viral suppression were significantly greater among TGWWH receiving GAHT when compared with those who were not. More research to evaluate the reasons behind this effect is needed.
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Affiliation(s)
- Nathan A Summers
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Adult Special Care Center, Regional One Health, Memphis, Tennessee, USA
| | - Trang T Huynh
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Ruth C Dunn
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Sara L Cross
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christian J Fuchs
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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18
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021. [PMID: 34370565 DOI: 10.1521/aeap.2021.33.4.345]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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19
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:345-360. [PMID: 34370565 PMCID: PMC8565450 DOI: 10.1521/aeap.2021.33.4.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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20
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Eastwood EA, Nace AJ, Hirshfield S, Birnbaum JM. Young Transgender Women of Color: Homelessness, Poverty, Childhood Sexual Abuse and Implications for HIV Care. AIDS Behav 2021; 25:96-106. [PMID: 31865517 DOI: 10.1007/s10461-019-02753-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study describes a sample of HIV+ young transgender women of color aged 18-24 and their experience with homelessness as part of a demonstration project of engagement and retention in HIV medical care funded by Health Resources and Services Administration. The study engaged transgender women of color in HIV care in nine sites across the US between 2012 and 2017. This analysis describes and compares transwomen who had been homeless in the last 6 months to those not homeless. We hypothesized that homelessness would compete with HIV care, food, shelter, and be associated with poverty. Variable domains included sociodemographic, mental health and substance use, HIV care, sexual risk behavior, social support from transgender and other friends, and childhood sexual abuse. There were 102 youth enrolled, 77 (75.5%) who had been homeless, and 25 (24.5%) who had not been homeless. Bivariate analyses showed that low income, sex work as source of income, inability to afford food, lack of viral load (VL) suppression, childhood sexual abuse, lower levels of social support, and higher levels of depression were associated with homelessness. A logistic regression model showed that being unable to afford food (AOR = 9.24, 95% CI 2.13-40.16), lack of VL suppression in last 6 months (AOR = 0.10, 95% CI .02-.57), and lack of transgender friend support (AOR = 0.09, 95% CI .02-.53) was associated with homelessness. Programs that place basic needs first-food and shelter-may be able to engage and assist young transgender women of color with HIV to survive and live healthier lives.
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Affiliation(s)
- Elizabeth A Eastwood
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA.
| | - Amanda J Nace
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey M Birnbaum
- Department of Pediatrics, SUNY Downstate Health Sciences University and SUNY Downstate School of Public Health, Brooklyn, NY, USA
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21
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Sevelius J, Chakravarty D, Neilands TB, Keatley J, Shade SB, Johnson MO, Rebchook G. Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV. AIDS Behav 2021; 25:64-71. [PMID: 31144131 DOI: 10.1007/s10461-019-02544-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.
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22
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Reback CJ, Rünger D, Fletcher JB. Drug Use is Associated with Delayed Advancement Along the HIV Care Continuum Among Transgender Women of Color. AIDS Behav 2021; 25:107-115. [PMID: 31187356 DOI: 10.1007/s10461-019-02555-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Transgender women are impacted by elevated rates of HIV infection and drug use. This study investigated effects of drug use on HIV care outcomes among transgender women of color living with HIV who enrolled in a combined peer health navigation (PHN) and contingency management intervention (N = 129). At baseline, 71.3% reported any drug use in the past 6 months. Linkage to HIV care was delayed for users of any stimulant compared to non-users of stimulants, and for methamphetamine users compared to non-users of methamphetamine. Any drug use, relative to no drug use, was associated with fewer HIV care visits (IRR 0.50, 95% CI [0.30, 0.85]), but did not significantly impact ART adherence, or attaining an undetectable viral load. PHN sessions were positively related to the number of HIV care visits (IRR 1.20, 95% CI [1.07, 1.34]), especially for users of any stimulant and for methamphetamine users, to ART adherence (OR 2.54, 95% CI [1.67, 3.86]), and to virological suppression (OR 7.57, 95% CI [1.64, 34.94]). These findings demonstrate the value of assessing drug use as a possible barrier to HIV care.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA.
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Dennis Rünger
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - Jesse B Fletcher
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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23
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Reisner SL, Deutsch MB, Mayer KH, Potter J, Gonzalez A, Keuroghlian AS, Hughto JM, Campbell J, Asquith A, Pardee DJ, Pletta DR, Radix A. Longitudinal Cohort Study of Gender Affirmation and HIV-Related Health in Transgender and Gender Diverse Adults: The LEGACY Project Protocol. JMIR Res Protoc 2021; 10:e24198. [PMID: 33646126 PMCID: PMC7961399 DOI: 10.2196/24198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background Transgender and gender diverse (TGD) adults in the United States experience health disparities, especially in HIV infection. Medical gender affirmation (eg, hormone therapy and gender-affirming surgeries) is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the effects of gender-affirming medical care on HIV-related outcomes. Objective This study aims to evaluate the effects of medical gender affirmation on HIV-related outcomes among TGD primary care patients. Secondary objectives include characterizing mental health, quality of life, and unmet medical gender affirmation needs. Methods LEGACY is a longitudinal, multisite, clinic-based cohort of adult TGD primary care patients from two federally qualified community health centers in the United States: Fenway Health in Boston, and Callen-Lorde Community Health Center in New York. Eligible adult TGD patients contribute electronic health record data to the LEGACY research data warehouse (RDW). Patients are also offered the option to participate in patient-reported surveys for 1 year of follow-up (baseline, 6-month, and 12-month assessments) with optional HIV and sexually transmitted infection (STI) testing. Biobehavioral data from the RDW, surveys, and biospecimen collection are linked. HIV-related clinical outcomes include pre-exposure prophylaxis uptake (patients without HIV), viral suppression (patients with HIV), and anogenital STI diagnoses (all patients). Medical gender affirmation includes hormones, surgeries, and nonhormonal and nonsurgical interventions (eg, voice therapy). Results The contract began in April 2018. The cohort design was informed by focus groups with TGD patients (n=28) conducted between August-October 2018 and in collaboration with a community advisory board, scientific advisory board, and site-specific research support coalitions. Prospective cohort enrollment began in February 2019, with enrollment expected to continue through August 2020. As of April 2020, 7821 patients are enrolled in the LEGACY RDW and 1756 have completed a baseline survey. Participants have a median age of 29 years (IQR 11; range 18-82). More than one-third (39.7%) are racial or ethnic minorities (1070/7821, 13.68% Black; 475/7821, 6.07% multiracial; 439/7821, 5.61% Asian or Pacific Islander; 1120/7821, 14.32% other or missing) and 14.73% (1152/7821) are Hispanic or Latinx. By gender identity, participants identify as 33.79% (2643/7821) male, 37.07% (2900/7821) female, 21.74% (1700/7821) nonbinary, and 7.39% (578/7821) are unsure or have missing data. Approximately half (52.0%) of the cohort was assigned female sex at birth, and 5.4% (421/7821) are living with HIV infection. Conclusions LEGACY is an unprecedented opportunity to evaluate the impact of medical gender affirmation on HIV-related health. The study uses a comprehensive research methodology linking TGD patient biobehavioral longitudinal data from multiple sources. Patient-centeredness and scientific rigor are assured through the ongoing engagement of TGD communities, clinicians, scientists, and site clinical staff undergirded by epidemiological methodology. Findings will inform evidence-based clinical care for TGD patients, including optimal interventions to improve HIV-related outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/24198
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Affiliation(s)
- Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Madeline B Deutsch
- University of California San Francisco, San Francisco, CA, United States
| | - Kenneth H Mayer
- Harvard Medical School, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer Potter
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex Gonzalez
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Jaclyn Mw Hughto
- Brown University School of Public Health, Providence, RI, United States.,Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | | | | | | | | | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
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24
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Badowski ME, Britt N, Huesgen EC, Lewis MM, Miller MM, Nowak K, Sherman E, Smith RO. Pharmacotherapy considerations in transgender individuals living with human immunodeficiency virus. Pharmacotherapy 2021; 41:299-314. [PMID: 33404067 DOI: 10.1002/phar.2499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022]
Abstract
Pharmacotherapy considerations are often a concern for transgender individuals who are living with human immunodeficiency virus (HIV) due to concerns for drug-drug interactions between their hormone and antiretroviral therapies. Many of the first-line therapies offered to patients for the management of HIV have reduced concerns for safety, resistance, and drug-drug interactions. In this review, we highlight common medications and important considerations for caring for transgender people living with HIV.
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Affiliation(s)
- Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nicholas Britt
- School of Pharmacy, The University of Kansas, Kansas City, Kansas, USA
| | | | - Michelle M Lewis
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Misty M Miller
- College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Elizabeth Sherman
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Renata O Smith
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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25
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King WM, Gamarel KE. A Scoping Review Examining Social and Legal Gender Affirmation and Health Among Transgender Populations. Transgend Health 2021; 6:5-22. [PMID: 33644318 PMCID: PMC7906235 DOI: 10.1089/trgh.2020.0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose: Transgender (trans) populations experience health inequities. Gender affirmation refers to psychological, social, legal, and medical validation of one's gender and is a key social determinant of trans health. The majority of research has focused on medical affirmation; however, less is known about the role of social and legal affirmation in shaping trans health. This review aimed to (1) examine how social and legal gender affirmation have been defined and operationalized and (2) evaluate the association between these forms of gender affirmation and health outcomes among trans populations in the United States. Methods: We conducted a systematic search of LGBT Life, PsycInfo, and PubMed using search strings targeting transgender populations and gender affirmation. This review includes 24 of those articles as well as 1 article retrieved through hand searching. We used a modified version of the National Institute of Health Quality Assessment Tool to evaluate study quality. Results: All studies relied on cross-sectional data. Studies measured and operationalized social and legal gender affirmation inconsistently, and some measures conflated social gender affirmation with other constructs. Health outcomes related to mental health, HIV, smoking, and health care utilization, and studies reported mixed results regarding both social and legal gender affirmation. The majority of studies had serious methodological limitations. Conclusion: Despite conceptual and methodological limitations, social and legal gender affirmation were related to several health outcomes. Study findings can be used to develop valid and reliable measures of these constructs to support future multilevel interventions that improve the health of trans communities.
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Affiliation(s)
- Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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26
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Papalini C, Lagi F, Schiaroli E, Sterrantino G, Francisci D. Transgender people living with HIV: characteristics and comparison to homosexual and heterosexual cisgender patients in two Italian teaching hospitals. Int J STD AIDS 2020; 32:194-198. [PMID: 33327898 DOI: 10.1177/0956462420950573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Regarding people living with HIV (PLHIV), little is known about the epidemiological characteristics and management decisions for transgender individuals. This retrospective study compared transgender and cisgender (homosexual and heterosexual) PLHIV at both the S. Maria della Misericordia of Perugia and Careggi of Firenze Teaching Hospitals from 2000 to 2018. Multivariate logistic regression was performed to analyse possible relationships between viral suppression (dependent variable) and age, sexually transmitted infections (STIs), and hepatitis diagnosis (independent variables). After analysing and comparing epidemiological and clinical data for 124 transgender, 180 homosexual cisgender and 188 heterosexual cisgender PLHIV, we found that transgender PLHIV, mostly Latin American sex workers, were more likely to have other STIs. Likewise, this subgroup, on average, was younger at the time of HIV diagnosis and more likely to be less adherent to care, consequently jeopardizing the achievement of viral suppression. Finally, the use of hormone therapy and gender confirmation surgery in transgender PLHIV contributed to specific management issues. To date, major attention has focused on studying the epidemiological characteristics of homosexual and heterosexual PLHIV. Our analysis found that transgender PLHIV were the least likely group to be adequately retained in the continuum of care and presented specific issues in part due to social and behavioural realities.
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Affiliation(s)
- Chiara Papalini
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Filippo Lagi
- Departement of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Schiaroli
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gaetana Sterrantino
- Departement of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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27
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Radix AE. Management and Prevention of HIV Among Transgender Adults. TOPICS IN ANTIVIRAL MEDICINE 2020; 28:474-478. [PMID: 34107207 PMCID: PMC8224242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transgender individuals face discrimination, violence, social exclusion, and other social, political, and economic factors that result in increased vulnerability to HIV. Rates of viral suppression and uptake of preexposure prophylaxis are lower among transgender individuals than the general population. HIV clinics can help improve these rates by promoting inclusivity and tailoring care to the specific needs of transgender patients. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Asa E. Radix, MD, PhD, MPH, on August 18, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-radix/.
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Affiliation(s)
- Asa E Radix
- New York University School of Medicine, New York, NY, USA
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28
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Rendina HJ, Talan AJ, Cienfuegos-Szalay J, Carter JA, Shalhav O. Treatment Is More Than Prevention: Perceived Personal and Social Benefits of Undetectable = Untransmittable Messaging Among Sexual Minority Men Living with HIV. AIDS Patient Care STDS 2020; 34:444-451. [PMID: 33064015 DOI: 10.1089/apc.2020.0137] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Research suggests that the science of undetectable viral load (VL) status and HIV transmission-conveyed with the slogan "Undetectable = Untransmittable" or "U = U"-has gaps in acceptance despite robust scientific evidence. Nonetheless, growing acceptance of U = U creates conditions for a shift in the sociopolitical and personal implications of viral suppression. We conducted an online survey over a 23-month period in 2018 and 2019 among 30,361 adolescent and adult (aged 13-99) sexual minority men living with HIV (SMM-LHIV) across the United States. We examined the impact of U = U on self-image, potential for changing societal HIV stigma, whether SMM-LHIV had ever spoken with a provider about viral suppression and HIV transmission, and primary sources of hearing about U = U. Approximately 80% of SMM-LHIV reported that U = U was beneficial for their self-image and societal HIV stigma, 58.6% reported it made them feel "much better" about their own HIV status, and 40.6% reporting it had the potential to make HIV stigma "much better." The most consistent factors associated with these beliefs centered around care engagement, particularly self-reported viral suppression and excellent antiretroviral therapy adherence. Two-thirds reported ever talking to a provider about VL and HIV transmission, although the primary sources for having heard about U = U were HIV and lesbian, gay, bisexual, transgender, and queer (LGBTQ) news media and personal profiles on networking apps. These findings demonstrate the significant personal and social importance of U = U for SMM-LHIV that go above-and-beyond the well-documented health benefits of viral suppression, suggesting that providers should consider routinely initiating conversations with patients around the multifaceted benefits (personal health, sexual safety and intimacy, increased self-image, and reduced social stigma) of viral suppression.
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Affiliation(s)
- H. Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Ali J. Talan
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
| | - Jorge Cienfuegos-Szalay
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Joseph A. Carter
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York, USA
| | - Ore Shalhav
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
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29
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Gosiker BJ, Lesko CR, Rich AJ, Crane HM, Kitahata MM, Reisner SL, Mayer KH, Fredericksen RJ, Chander G, Mathews WC, Poteat TC. Cardiovascular disease risk among transgender women living with HIV in the United States. PLoS One 2020; 15:e0236177. [PMID: 32687532 PMCID: PMC7371206 DOI: 10.1371/journal.pone.0236177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transgender women (TW) are disproportionately affected by both HIV and cardiovascular disease (CVD). OBJECTIVES We aim to quantify prevalence of elevated predicted CVD risk for TW compared to cisgender women (CW) and cisgender men (CM) in HIV care and describe the impact of multiple operationalizations of CVD risk score calculations for TW. DESIGN We conducted a cross-sectional analysis of patients engaged in HIV care between October 2014 and February 2018. SETTING The Centers for AIDS Research Network of Integrated Clinical Systems, a collaboration of 8 HIV clinical sites in the United States contributed data for this analysis. PATIENTS 221 TW, 2983 CW, and 13467 CM. MEASUREMENTS The measure of interest is prevalence of elevated 10-year cardiovascular disease risk based on ACC/AHA Pooled Cohort Risk Assessment equations (PCE) and the Framingham Risk Score (FRS), calculated for TW by: birth-assigned sex (male); history of exogenous sex hormone use (female/male); and current gender (female). RESULTS Using birth-assigned sex, the adjusted prevalence ratio (aPR) was 2.52 (95% CI: 1.08,5.86) and 2.58 (95% CI: 1.71,3.89) comparing TW to CW, by PCE and FRS, respectively. It was 1.25 (95% CI: 0.54,2.87) and 1.25 (95% CI: 0.84,1.86) comparing TW to CM, by PCE and FRS, respectively. If TW were classified according to current gender versus birth-assigned sex, their predicted CVD risk scores were lower. LIMITATIONS PCE and FRS have not been validated in TW with HIV. Few adjudicated CVD events in the data set precluded analyses based on clinical outcomes. CONCLUSIONS After adjustment for demographics and history of HIV care, prevalence of elevated CVD risk in TW was similar to CM and equal to or higher than in CW, depending operationalization of the sex variable. Future studies with CVD outcomes are needed to help clinicians accurately estimate CVD risk among TW with HIV.
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Affiliation(s)
- Bennett J. Gosiker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ashleigh J. Rich
- School of Population and Public Health, Faculty of Medicince, University of British Columbia, Vancouver, BC, Canada
| | - Heidi M. Crane
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States of America
| | - Mari M. Kitahata
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States of America
| | - Sari L. Reisner
- The Fenway Institute, Boston, MA, United States of America
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute, Boston, MA, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Rob J. Fredericksen
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States of America
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - William C. Mathews
- School of Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
- * E-mail:
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30
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Identifying Opportunities for Collaboration Across the Social Sciences to Reach the 10-10-10: A Multilevel Approach. J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S118-S123. [PMID: 31658198 PMCID: PMC6820711 DOI: 10.1097/qai.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The national and global strategy to combat HIV, often referred to as the "90-90-90," aims to diagnose 90% of people living with HIV, get 90% of those diagnosed onto antiretroviral treatment (ART), and achieve viral suppression in 90% of those on ART. The remaining 10-10-10 who will be undiagnosed, not on ART, or not virally suppressed, include vulnerable persons and populations most affected by social determinants of health. Given their foci on the social determinants of health at the individual, social, and structural levels, social scientists are in a prime position to help reach the 10-10-10. A potentially effective way for social scientists to achieve this goal is to examine the issues that affect the 10-10-10 using a multilevel framework, to understand at what levels their own approaches fit within such a multilevel framework, and to seek intentional collaborations with other social scientists who may work at different levels but whose approaches may complement their own within multilevel collaborations. APPROACH The present article describes how a multilevel framework can guide collaboration across disciplines within the social sciences toward the common goal of reaching the 10-10-10. CONCLUSIONS Within a multilevel framework, social scientists can work collaboratively to address the needs of individuals among the 10-10-10 within the social and structural contexts (eg, social norms, stigma, poverty, and barriers to care) that affect their health. Such an approach draws on the unique strengths and approaches of different social-science disciplines while also building capacity for individuals most affected by social determinants of health.
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Klein PW, Psihopaidas D, Xavier J, Cohen SM. HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration's Ryan White HIV/AIDS Program: A retrospective study. PLoS Med 2020; 17:e1003125. [PMID: 32463815 PMCID: PMC7255591 DOI: 10.1371/journal.pmed.1003125] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/21/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the United States, approximately one-fifth of transgender women are living with HIV-nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men. METHODS AND FINDINGS We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92-0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41-0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42-0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care. CONCLUSIONS In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.
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Affiliation(s)
- Pamela W. Klein
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
- * E-mail:
| | - Demetrios Psihopaidas
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Jessica Xavier
- Independent Consultant, Silver Spring, Maryland, United States of America
| | - Stacy M. Cohen
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
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Rich AJ, Williams J, Malik M, Wirtz A, Reisner S, DuBois LZ, Juster RP, Lesko CR, Davis N, Althoff KN, Cannon C, Mayer K, Elliott A, Poteat T. Biopsychosocial Mechanisms Linking Gender Minority Stress to HIV Comorbidities Among Black and Latina Transgender Women (LITE Plus): Protocol for a Mixed Methods Longitudinal Study. JMIR Res Protoc 2020; 9:e17076. [PMID: 32281542 PMCID: PMC7186865 DOI: 10.2196/17076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background Black and Latina transgender women (TW) experience a disparate burden of HIV and related comorbidities, including poor mental health and cardiovascular disease (CVD) risks. Pervasive multilevel stigma and discrimination operate as psychosocial stressors for TW living with HIV and shape health disparities for this population. Gender-affirming hormone therapy (GAHT) is commonly used by TW to facilitate alignment of the body with gender identity; in the context of stigma, GAHT may both improve mental health and increase CVD risks. Objective This study aims to quantify the longitudinal relationship between stigma and chronic stress among black and Latina TW living with HIV. Secondary objectives include identifying pathways linking chronic stress to HIV comorbidities and exploring chronic stress as a mediator in the pathway linking stigma and GAHT to CVD comorbidities. Methods This US-based mixed methods longitudinal study will enroll a prospective cohort of 200 black and Latina TW living with HIV, collecting quantitative survey data, qualitative interviews, and biomarkers of chronic stress. Interviewer-administered surveys will include validated psychosocial measures of self-reported stigma and discrimination, perceived stress, CVD risk factors, mental health, access to gender-affirming care, coping, and social support. Medical record abstraction will collect data on GAHT use, CD4 count, HIV viral load, antiretroviral therapy, treatment, and comorbid conditions. Clinical measures will include physiological biomarkers as well as salivary and blood-based biomarkers of chronic stress. Survey data will be collected every 6 months (baseline, and 6, 12, 18, and 24 months), and biospecimens will be collected at baseline and at 12 and 24 months. A purposive subsample (stratified by use of GAHT and presence of depressive symptoms) of 20 to 30 TW living with HIV will be invited to participate in in-depth interviews at 6 and 18 months to explore experiences of intersectional stigma, chronic stress, and the role of GAHT in their lives. Results This study was funded by the National Institute on Minority Health and Health Disparities in December 2018. The study community advisory board and scientific advisors provided critical input on study design. Recruitment began in October 2019 (n=29 participants as of submission) and data collection will continue through 2022, with publication of baseline results anticipated summer 2021. Conclusions This study will focus on black and Latina TW living with HIV, an understudied health disparities population, advance both stigma and intersectionality research, and move chronic stress physiology research toward a more nuanced understanding of sex and gender. The comprehensive methodology will support the exploration of the role of exogenous estrogen in the pathways between stress and HIV comorbidities, elucidating the role of GAHT in the stress-health relationship. Finally, this study will provide longitudinal evidence of the impact of stigma-related chronic stress on the lives of black and Latina TW living with HIV integrating qualitative and quantitative data with psychosocial, clinical, and biological measures. International Registered Report Identifier (IRRID) DERR1-10.2196/17076
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Affiliation(s)
- Ashleigh J Rich
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Williams
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Mannat Malik
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Andrea Wirtz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sari Reisner
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - L Zachary DuBois
- Department of Anthropology, University of Oregon, Eugene, OR, United States
| | - Robert Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Catherine R Lesko
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Nicole Davis
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Kenneth Mayer
- TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Ayana Elliott
- National LGBT Health Education Center, Boston, MA, United States
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
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HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. J Acquir Immune Defic Syndr 2019; 80:166-173. [PMID: 30383588 DOI: 10.1097/qai.0000000000001891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART); yet, no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment, including explanatory pathways using mediation analysis. SETTING Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS Participants were assessed using an audio computer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates and PROCESS macro to test the explanatory pathway (ie, mediational effect) for optimal ART adherence. RESULTS Among 121 participants, almost 40% reported suboptimal adherence to ART. Optimal ART adherence was significantly associated with being virally suppressed [adjusted odds ratio (aOR) = 6.470, P = 0.038], higher motivation to adhere to ART (aOR = 1.171, P = 0.011), and lower anticipated HIV-related stigma (aOR = 0.384, P = 0.015). Furthermore, results revealed an indirect effect of motivation on the relationship between HIV stigma and ART adherence (effect = -0.121, P = 0.043), thus supporting the mediation effect. CONCLUSIONS Our findings underscore the complexities surrounding ART adherence, even in patients on methadone maintenance treatment. These findings provide insights on how to more effectively intervene to optimize HIV treatment outcomes, including HIV treatment-as-prevention initiatives, in methadone-maintained patients.
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Teti M, Bauerband LA, Altman C. Adherence to Antiretroviral Therapy Among Transgender and Gender Nonconforming People Living with HIV: Findings from the 2015 U.S. Trans Survey. Transgend Health 2019; 4:262-269. [PMID: 31656854 PMCID: PMC6814081 DOI: 10.1089/trgh.2019.0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, Missouri
| | - L A Bauerband
- Department of Health Sciences, University of Missouri, Columbia, Missouri
| | - Claire Altman
- Department of Health Sciences, University of Missouri, Columbia, Missouri
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Restar AJ, Santamaria EK, Adia A, Nazareno J, Chan R, Lurie M, Sandfort T, Hernandez L, Cu-Uvin S, Operario D. Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women. PLoS One 2019; 14:e0224133. [PMID: 31634378 PMCID: PMC6802834 DOI: 10.1371/journal.pone.0224133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration. METHODS We conducted semi-structured interviews with trans women (n = 9) who self-reported as HIV-positive and their HIV providers (n = 15) from community-based venues (e.g., clinics) in Manila, Philippines. RESULTS We identified five key themes from our qualitative data: (1) provider's concerns; (2) patient's goals; (3) affirmative vs. non-affirmative provider rhetoric; (4) alignment vs. misalignment of provider rhetoric to patient goals; and (5) FHT and ART-related decisions. Based on these themes, we describe a gender-affirmative HIV care framework to understand FHT-ART decisions among trans women living with HIV. Based on our data, this framework shows that provider-patient communications regarding ART and FHT consists primarily of provider concerns and patient goals regarding FHT. These communications can take on a gender-affirmative or non-affirmative style of rhetoric that either aligns or misaligns with patient goals and may lead to differences in FHT and ART-related decisions among trans women living with HIV. CONCLUSION There exist mixed regimens and beliefs about taking FHT and ART among this sample of trans women. While trans participants' main source of health information is their HIV provider, providers are likely to communicate non-affirmative rhetoric that negatively impacts trans women's decision to take FHT and ART. Research is needed to elucidate co-prescriptions of gender-affirmative services with HIV care among this group in the Philippines.
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Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
- amfAR, The Foundation of AIDS Research, Washington, DC, United States of America
| | - E. Karina Santamaria
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
| | - Randolph Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Mark Lurie
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division on Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
- Providence-Boston Center for AIDS Research, Providence, RI, United States of America
- Miriam Hospital, Department of Medicine, Providence, RI, United States of America
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
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Rosen JG, Malik M, Cooney EE, Wirtz AL, Yamanis T, Lujan M, Cannon C, Hardy D, Poteat T. Antiretroviral Treatment Interruptions Among Black and Latina Transgender Women Living with HIV: Characterizing Co-occurring, Multilevel Factors Using the Gender Affirmation Framework. AIDS Behav 2019; 23:2588-2599. [PMID: 31263998 PMCID: PMC6768710 DOI: 10.1007/s10461-019-02581-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Black and Latina transgender women (BLTW) are disproportionately impacted by HIV but remain underrepresented in HIV and health services research. Between March 2016 and May 2017, BLTW (N = 201) were recruited in Baltimore, Maryland and Washington, DC through convenience sampling for a survey assessing multilevel determinants of HIV risk and treatment outcomes. Interviews concluded with a rapid oral HIV test. Bivariate and multivariable logistic regression modeling was performed to identify gender affirmation-related correlates of self-reported HIV treatment interruptions (HIVTIs) among BLTW living with HIV who had initiated antiretroviral therapy (ART) (n = 96). Among them, 57.3% (n = 55) reported at least one HIVTI. Unmet surgical needs (aOR = 1.6), past-year marijuana use (aOR = 14.6), and no current hormone use (aOR = 24.9) were significantly (p < 0.05) associated with HIVTIs in multivariable analysis. Unmet need for gender affirmation may inhibit ART adherence, highlighting opportunities to mitigate care interruptions in alignment with community needs and goals.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mannat Malik
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Cooney
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thespina Yamanis
- School of International Service, American University, Washington, DC, USA
| | - Maren Lujan
- School of International Service, American University, Washington, DC, USA
| | | | - David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Social Medicine, University of North Carolina School of Medicine, 333 South Columbia Street, MacNider Hall, Room #348/CB #7240, Chapel Hill, NC, 27599-7240, USA.
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Reback CJ, Rünger D. Technology use to facilitate health care among young adult transgender women living with HIV. AIDS Care 2019; 32:785-792. [PMID: 31405287 DOI: 10.1080/09540121.2019.1653439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how young adult transgender women living with HIV use digital technologies to facilitate their health care. This study examined the use of digital technologies to search for health information and support HIV care among young adult transgender women living with HIV (N = 130) in Los Angeles County, California. About half used the Internet "all the time" to search for transgender-specific resources (TSR; 53.8%) and for sexual health information (SHI; 51.5%). Less than half (39.2%) received digital HIV care reminders and, of those taking ART medication (n = 63), 36.5% received digital medication reminders. Internet information search was associated with Hispanic/Latina ethnicity (TSR: OR = 0.23, 95% CI [0.09, 0.58]; SHI: OR = 0.29, 95% CI [0.12, 0.73]) and higher (≥ $500) past-month income (TSR: OR = 2.67, 95% CI [1.13, 6.34]; SHI: OR = 2.67, 95% CI [1.14, 6.26]); receiving digital medication reminders with post-secondary educational attainment (OR = 5.70, 95% CI [1.04, 31.19]) and higher income (OR = 6.73, 95% CI [1.52, 29.67]). Receiving analog, but not digital, HIV care reminders was associated with engagement in HIV care (OR = 2.37, 95% CI [1.13, 5.00]) and ART uptake (OR = 2.18, 95% CI [1.06, 4.48]. Digital technology use was common for health-related searches but not for supporting HIV care.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., Los Angeles, CA, USA.,Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Dennis Rünger
- Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
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Lacombe-Duncan A, Bauer GR, Logie CH, Newman PA, Shokoohi M, Kay ES, Persad Y, O'Brien N, Kaida A, de Pokomandy A, Loutfy M. The HIV Care Cascade Among Transgender Women with HIV in Canada: A Mixed-Methods Study. AIDS Patient Care STDS 2019; 33:308-322. [PMID: 31260342 DOI: 10.1089/apc.2019.0013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Scant research has explored the engagement of transgender (trans) women living with HIV (WLWH) in the HIV care cascade, particularly in universal health care settings like Canada. This convergent parallel, mixed-methods study drew on cross-sectional quantitative data from 50 trans WLWH in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) and qualitative semistructured interview data from a subsample of 11 participants. Descriptive analyses were used to describe proportions of trans WLWH at five steps of the HIV care cascade and bivariate analyses to determine associations between hypothesized barriers/facilitators and HIV care cascade outcomes. Framework analysis was used to describe barriers and facilitators to HIV care engagement. Quantitative and qualitative data were then compared and contrasted. While use of purposive sampling, including recruitment through AIDS Service Organizations and HIV clinics, may have led to oversampling of trans WLWH who already had access to care, gaps were still seen in antiretroviral therapy (ART) outcomes (current ART use: 78%; ≥95% adherence among those currently taking ART: 67%). The number of years living with HIV was positively associated with HIV care cascade engagement. Factors associated with lower engagement included: higher health-related quality of life, depressive and post-traumatic stress disorder symptoms, barriers to access to care, transphobia, HIV-related stigma, and housing insecurity. Qualitative findings converged and expanded on how physical health, and social and structural marginalization, influence trans WLWH's engagement in HIV care. Qualitative findings elaborated on the importance of ART-related factors in impeding or facilitating engagement, including concerns about feminizing hormone-ART drug-drug interactions. Mixed-methods findings reveal how trans WLWH experience barriers common to other people living with HIV, and also experience unique barriers as a result of trans and HIV experiences.
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Affiliation(s)
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Emma Sophia Kay
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Lama JR, Mayer KH, Perez-Brumer AG, Huerta L, Sanchez H, Clark JL, Sanchez J, Reisner SL. Integration of Gender-Affirming Primary Care and Peer Navigation With HIV Prevention and Treatment Services to Improve the Health of Transgender Women: Protocol for a Prospective Longitudinal Cohort Study. JMIR Res Protoc 2019; 8:e14091. [PMID: 31250829 PMCID: PMC6620883 DOI: 10.2196/14091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been shown to be effective to engage and retain underserved populations living with HIV in stable primary medical care. OBJECTIVE This study aims to assess the feasibility and acceptability of an integrated innovative HIV service delivery model designed to improve HIV prevention and care by combining gender-affirming primary care and peer navigation with HIV prevention and treatment services. METHODS A 12-month, nonrandomized, single-arm cohort study was implemented in Lima, Peru, among adult individuals, assigned a male sex at birth, who identified themselves as transgender women, regardless of initiation or completion of medical gender affirmation, and who were unaware of their HIV serostatus or were living with HIV but not engaged in HIV treatment. HIV-negative participants received quarterly HIV testing and were offered to initiate pre-exposure prophylaxis. HIV-positive participants were offered to initiate antiretroviral treatment and underwent quarterly plasma HIV-1 RNA and peripheral CD4+ lymphocyte cell count monitoring. All participants received feminizing hormone therapy and adherence counseling and education on their use. Peer health navigation facilitated retention in care by visiting participants at home, work, or socialization venues, or by contacting them by social media and phone. RESULTS Patient recruitment started in October 2016 and finished in March 2017. The cohort ended follow-up on March 2018. Data analysis is currently underway. CONCLUSIONS Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for transgender women are vital to curb the burden of HIV epidemic for this key population. Findings of this intervention will inform future policies and research, including evaluation of its efficacy in a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03757117; https://clinicaltrials.gov/ct2/show/NCT03757117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14091.
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Affiliation(s)
- Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | | | - Jesse L Clark
- Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sari L Reisner
- The Fenway Institute, Boston, MA, United States
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
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Vaitses Fontanari AM, Zanella GI, Feijó M, Churchill S, Rodrigues Lobato MI, Costa AB. HIV-related care for transgender people: A systematic review of studies from around the world. Soc Sci Med 2019; 230:280-294. [PMID: 31035207 DOI: 10.1016/j.socscimed.2019.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 01/08/2023]
Abstract
RATIONALE Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people. OBJECTIVE The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people. METHOD Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations. RESULTS From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment. CONCLUSIONS The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.
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Affiliation(s)
- Anna Martha Vaitses Fontanari
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | - Marina Feijó
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maria Inês Rodrigues Lobato
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Baguso GN, Turner CM, Santos G, Raymond HF, Dawson‐Rose C, Lin J, Wilson EC. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc 2019; 22:e25270. [PMID: 31037858 PMCID: PMC6488760 DOI: 10.1002/jia2.25270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/07/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To examine the HIV care continuum for transwomen living in San Francisco and to determine factors associated with poor HIV-related health outcomes. METHODS Data were collected from 2016 to 2017 with transwomen in San Francisco. Respondent-driven sampling (RDS) was used to recruit a population-based sample. Bivariate associations were assessed, and RDS-weighted multivariable logistic regression was used to identify associations between exposures and outcomes along the HIV care continuum. RESULTS Of the 123 self-identified transwomen in this analysis, ages ranged from 23 to 71 years with a majority identifying as Latina (40.8%) and African American (29.2%). An estimate of 14.3% of participants were not engaged in care, 13% were not currently on antiretroviral therapy (ART), 22.2% had a self-reported detectable viral load and 13.5% had unknown viral load. Those using hormones had lower odds of not being on ART compared to those who did not use hormones. Those with unstable housing had a higher relative risk ratio of having a detectable viral load. Those who experienced both anti-trans discrimination and racism had higher odds of not being in HIV care. CONCLUSIONS San Francisco has made substantial progress engaging transwomen in the HIV care continuum, but the final push to ensure viral suppression will require addressing social determinants. Future interventions to increase HIV care engagement, ART use and viral suppression among transwomen must address housing needs and risks related to the overlapping effect of both anti-trans discrimination and racism.
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Affiliation(s)
- Glenda N Baguso
- Department of Community Health SystemsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Caitlin M Turner
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Glenn‐Milo Santos
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - H Fisher Raymond
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Carol Dawson‐Rose
- Department of Community Health SystemsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Jess Lin
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Erin C Wilson
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
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Abstract
Purpose: An emerging body of research analyzes the scope, ethics, and inequalities of web-based crowdfunding to raise money for medical expenses related to illness or injury. To date, little research has investigated how transgender communities utilize crowdfunding expenses related to gender affirming medical care. Methods: Using GoFundMe.com, we created a data set of 391 crowdfunding campaigns for gender-affirming care created from 2012 to 2016. In addition to descriptive statistics of recipient demographics and campaign financials, we conducted hierarchical multiple regression analyses to determine the factors associated with financial outcomes of fundraising for medical expenses. Results: Findings indicate that the majority of campaigns were used to fund chest surgeries among young, white, binary-identified trans men in the United States. Few campaigns met their fundraising goal. Being a trans man whose Facebook community shares the crowdfunding campaign is predictive of meeting a higher percentage of the fundraising goal, whereas being a trans woman whose Facebook community shares the campaign is predictive of raising more money. Conclusion: The use of crowdfunding for gender affirming highlights the difficulties that transgender persons face with using private and public health care programs to fund medically necessary care. Health care providers should exercise caution in recommending crowdfunding as a viable strategy to raise money for out-of-pocket costs.
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Affiliation(s)
- Chris A. Barcelos
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin
- Address correspondence to: Chris A. Barcelos, PhD, MPPA, Department of Gender and Women's Studies, University of Wisconsin-Madison, 475 N. Charter Street, Madison, WI 53706,
| | - Stephanie L. Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin
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Canoy N, Thapa S, Hannes K. Transgender persons' HIV care (dis)engagement: a qualitative evidence synthesis protocol from an ecological systems theory perspective. BMJ Open 2019; 9:e025475. [PMID: 30670527 PMCID: PMC6347901 DOI: 10.1136/bmjopen-2018-025475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION There seems to be little information on interactional patterns of enabling and constraining factors contributing to HIV care engagement across systems and across time. Understanding these patterns from a (micro-meso-macro-exo) systems perspective can provide rich insights on relevant social networks affecting transgender populations. In this review, we will synthesise the wealth of literature on transgender persons' engagement in the HIV care continuum. METHODS AND ANALYSIS We will perform a networked systems approach to qualitative evidence synthesis of relevant qualitative research data generated from primary qualitative, mixed-method and evaluation studies exploring HIV care engagement among diverse transgender populations. Studies not using qualitative methods and studies not published in English will be excluded from this review. Empirical studies will be identified via a search in major databases such as PubMed, Scopus, ERIC, Embase, Web of Science, Sociological Abstracts, PsychInfo and Social Services Abstract in January 2019. Two reviewers will independently screen the studies for inclusion, assess their quality and extract data. In case some of the system levels in the network are ill-covered by empirical studies, non-empirical studies will be considered for inclusion. The qualitative evidence synthesis includes a summary of descriptive data (first order), an exploration of relationships between system levels or their components (second order) and a structured summary of research evidence through narrative synthesis. The narrative synthesis will be extended with an overall social network analysis that visualises important nodes and links cutting across ecological systems. ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. Review findings will be disseminated via peer-reviewed academic journals and a targeted information campaign towards organisations that work with our population of interest. PROSPERO REGISTRATION NUMBER CRD42018089956.
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Affiliation(s)
- Nico Canoy
- Department of Psychology, Ateneo de Manila University, Quezon City, Manila, Philippines
| | - Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karin Hannes
- Social Research Methodology Group, Faculty of Social Sciences, Leuven, Belgium
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Harper GW, Jadwin-Cakmak LA, Popoff E, Campbell BA, Granderson R, Wesp LM, Emmanuel, Straub, Bruce, Kerr, Belzer, Tucker, Franco, D'Angelo, Trexler, Carr, Sinkfield, Douglas, Tanney, DiBenedetto, Franklin, Smith, Henry-Reid, Bojan, Balthazar, Futterman, Campos, Wesp, Nazario, Reopell, Abdalian, Kozina, Baker, Wilkes, Friedman, Maturo, Gaur, Flynn, Dillard, Hurd-Sawyer, Paul, Head, Sierra, Secord, Cromer, Walters, Houston, George-Agwu, Anderson, Worrel-Thorne, Mayer, Dormitzer, Massaquoi, Gelman, Reirden, Hahn, Bernath, C. Wilson, C. Partlow, G. Price. Transgender and Other Gender-Diverse Youth's Progression Through the HIV Continuum of Care: Socioecological System Barriers. AIDS Patient Care STDS 2019; 33:32-43. [PMID: 30601061 DOI: 10.1089/apc.2018.0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transgender and other gender-diverse youth (TGDY) are disproportionately affected by HIV and in need of developmentally and culturally appropriate services as they progress along the HIV continuum of care (CoC). We conducted a phenomenological analysis of 66 in-depth interviews with TGDY living with HIV (ages 16-24) from 14 cities across the United States about their experiences within the different stages of the HIV CoC. TGDY described experiencing a wide variety of barriers across each examined stage of the HIV CoC, including HIV testing, linkage to care, retention in care, initiation of antiretroviral therapy, and adherence to antiretroviral therapy. Within these CoC stages, TGDY experienced barriers to care across all socioecological systems, including the sociocultural systems, clinic/organizational systems, and interpersonal systems. Barrier themes remained relatively constant for all stages of the CoC, although the way each thematic category of barrier (e.g., the theme of societal oppression and discrimination within the sociocultural level) was experienced varied by stage. Although overall thematic categories were typically not focused solely on threats to participants' gender identity and expression, specific descriptions of the nature of the thematic barriers were related to gender identity and gender expression. Implications of the findings for future research and practice are discussed.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Laura A. Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Elliot Popoff
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Bré Anne Campbell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ricky Granderson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Linda M. Wesp
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin
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Sweileh WM. Global research output on HIV/AIDS-related medication adherence from 1980 to 2017. BMC Health Serv Res 2018; 18:765. [PMID: 30305093 PMCID: PMC6180611 DOI: 10.1186/s12913-018-3568-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND "Human Immunodeficiency Virus (HIV)" and Acquired Immunodeficiency Syndrome (AIDS) are global health burden. Medication adherence in people living with HIV (PLWH) is a key element in reducing morbidity and mortality. Quantitative and qualitative assessment of research activity helps identify research gaps as well as efforts implemented to improve adherence behaviors in PLWH. The aim of the current study was to assess and analyze literature on HIV/AIDS-related medication adherence using bibliometric methods. METHODS SciVerse Scopus was used to accomplish the purpose of the current study. The study period included all times up to 2017. The analysis was restricted to documents published in academic journals. RESULTS Search strategy retrieved 3021 documents with an average of 32.5 citations per document, an h-index of 136, and an average of 4.4 authors per documents. The volume of literature on HIV/AIDS-related medication adherence constituted 1.3% of the overall HIV/AIDS literature. There was a significant (p < 0.01; r = 0.9) correlation between the growth of publications in AIDS-related stigma and medication adherence. The regions of America (567.9) had the highest research output per one million infected people (567.9) followed by the European region (314.3), Western Pacific Region (70.7), Eastern Mediterranean region (31.4), South East Asia (34.0), and Africa (19.3). Geographical distribution of publications showed an active contribution of certain countries in the Southern and Eastern region of Sub-Saharan Africa. Harvard University (8.4%; n = 254) was the most active institution. The top cited documents focused on the impact of adherence on disease outcome and the impact of text messages on improving medication adherence. CONCLUSION Research on medication adherence in PLWH showed regional variations. International research collaboration with high burden regions such as Sub-Saharan Africa needs to be strengthened to achieve the global target of ending AIDS as a public health threat by 2030.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Crosby RA, Salazar LF, Hill BJ. Correlates of Not Using Antiretroviral Therapy Among Transwomen Living with HIV: The Unique Role of Personal Competence. Transgend Health 2018; 3:141-146. [PMID: 30094338 PMCID: PMC6083205 DOI: 10.1089/trgh.2018.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose: This study tested three psychosocial measures for their potential to serve as counseling goals for promoting ART to transgender women living with HIV (TWLH). Methods: Among 69 TWLH, 17.4% were not taking ART; these volunteers were compared to the remainder using multivariate regression analyses. Results: Only one psychosocial measure achieved significance: Personal Competence (Adjusted Odds Ratio = 0.80, 95% CI = 0.67-0.97, P = 0.02). Because this was a continuous measure, assessed on a 7-point scale, the protective adjusted odds ratio of 0.80 represents a 20% reduction in the odds of not taking ART for each unit of increase in this construct. Conclusion: Findings suggest a potential counseling goal for TWLH not taking ART.
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Affiliation(s)
- Richard A. Crosby
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Laura F. Salazar
- Department of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Brandon J. Hill
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, Illinois
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Morrison MA, Bishop CJ, Morrison TG. What is the best measure of discrimination against trans people?: A systematic review of the psychometric literature. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1484798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - CJ Bishop
- Department of Psychology Saskatoon, University of Saskatchewan, SK, Canada
| | - Todd G. Morrison
- Department of Psychology Saskatoon, University of Saskatchewan, SK, Canada
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Gianella S, Sonya Haw J, Blumenthal J, Sullivan B, Smith D. The Importance of Human Immunodeficiency Virus Research for Transgender and Gender-Nonbinary Individuals. Clin Infect Dis 2018; 66:1460-1466. [PMID: 29126186 PMCID: PMC5905620 DOI: 10.1093/cid/cix990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 02/04/2023] Open
Abstract
Transgender and gender-nonbinary (trans/GNB) individuals are disproportionally affected by human immunodeficiency virus (HIV), yet they are not adequately represented in HIV research and often underserved in clinical care. By building on community strengths and addressing structural, psychological and biological challenges, we can improve the engagement of trans/GNB people in research and ultimately improve prevention, testing, and care for this population. Here, we review the current state of the science related to HIV for trans/GNB people and discuss next steps to expand research that aims to improve the lives and well-being of trans/GNB persons.
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Affiliation(s)
| | - J Sonya Haw
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Davey Smith
- University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, California
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Driving factors of retention in care among HIV-positive MSM and transwomen in Indonesia: A cross-sectional study. PLoS One 2018; 13:e0191255. [PMID: 29342172 PMCID: PMC5771583 DOI: 10.1371/journal.pone.0191255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
Little is known about the prevalence of and factors that influence retention in HIV-related care among Indonesian men who have sex with men (MSM) and transgender women (transwomen, or waria in Indonesian term). Therefore, we explored the driving factors of retention in care among HIV-positive MSM and waria in Indonesia. This cross-sectional study involved 298 self-reported HIV-positive MSM (n = 165) and waria (n = 133). Participants were recruited using targeted sampling and interviewed using a structured questionnaire. We applied a four-step model building process using multivariable logistic regression to examine how sociodemographic, predisposing, enabling, and reinforcing factors were associated with retention in care. Overall, 78.5% of participants were linked to HIV care within 3 months after diagnosis or earlier, and 66.4% were adequately retained in care (at least one health care visit every three months once a person is diagnosed with HIV). Being on antiretroviral therapy (adjusted odds ratio [AOR] = 6.00; 95% confidence interval [CI]: 2.93-12.3), using the Internet to find HIV-related information (AOR = 2.15; 95% CI: 1.00-4.59), and having medical insurance (AOR = 2.84; 95% CI: 1.27-6.34) were associated with adequate retention in care. Involvement with an HIV-related organization was associated negatively with retention in care (AOR = 0.47; 95% CI: 0.24-0.95). Future interventions should increase health insurance coverage and utilize the Internet to help MSM and waria to remain in HIV-related care, thereby assisting them in achieving viral suppression.
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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: 10] [Impact Index Per Article: 1.4] [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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