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Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, Safren S, Golub SA, Patel VV. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care 2023; 35:572-580. [PMID: 35819879 PMCID: PMC9834431 DOI: 10.1080/09540121.2022.2099511] [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] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/04/2022] [Indexed: 01/14/2023]
Abstract
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.
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Affiliation(s)
| | | | | | | | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
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Wolfe HL, Drainoni ML, Klasko-Foster L, Fix GM, Siegel J, Mimiaga MJ, Reisner SL, Hughto JM. Structural Equation Modeling of Stigma and HIV Prevention Clinical Services Among Transgender and Gender Diverse Adults: The Mediating Role of Substance Use and HIV Sexual Risk. J Acquir Immune Defic Syndr 2023; 92:300-309. [PMID: 36515898 PMCID: PMC9974738 DOI: 10.1097/qai.0000000000003144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) adults experience high levels of stigma that contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV compared to cisgender adults, TGD individuals may be less likely to engage in health care to avoid further discrimination. SETTING This analysis included 529 TGD adults in Massachusetts and Rhode Island who were HIV negative or had an unknown HIV serostatus and were purposively sampled between March and August 2019. METHODS We used structural equation modeling to test whether substance use, HIV sexual risk behaviors (ie, condom use, sex work, and multiple partners), and receiving gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (ie, HIV prevention programs, PrEP use, and HIV testing). RESULTS Substance use and HIV sexual risk mediated the relationship between TGD-related stigma and utilization of HIV prevention clinical services (β = 0.08; 95% CI = 0.05, 0.17; P = 0.03 and β = 0.26; 95% CI = 0.14 to 0.37; P < 0.001). Having a hormone therapy prescription was not a mediator between TGD-related stigma and HIV prevention clinical services. CONCLUSIONS Future interventions that aim to improve HIV prevention clinical services among TGD adults should consider the impact of TGD-related stigma on participants' substance use and sexual risk behaviors. These efforts require that health care organizations and community organizations make a deliberate investment in the reach and success of interventions and programs.
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Affiliation(s)
- Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA
- Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Gemmae M. Fix
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Jennifer Siegel
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA
| | - Matthew J. Mimiaga
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- University of California Los Angeles Center for LGBTQ Advocacy, Research & Health, Los Angeles, CA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- General Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaclyn M.W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
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3
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Haghiri-Vijeh R, Clark N. "If You Can Just Break the Stigma Around It": LGBTQI+ Migrants' Experiences of Stigma and Mental Health. QUALITATIVE HEALTH RESEARCH 2022; 32:1595-1606. [PMID: 35811568 DOI: 10.1177/10497323221111363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Migrants, that is people who experience forced displacement or move based on being lesbian, gay, bisexual, trans, two-spirit, queer, and intersex (LGBTQI+), experience increased trauma and stigma when compared to heterosexual and cisgender people. The aim of this paper is to highlight LGBTQI+ migrants' experiences of health and social care encounters in Canada. Gadamerian hermeneutics and an intersectionality lens was used to understand LGBTQI+ migrants' experiences. A total of 16 semi-structured individual interviews were conducted with LGBTQI+ migrants. Themes of stigma and discrimination were identified as (1) "I never went back": Stigma as an exclusionary experience, (2) "Is [your country of birth] really that bad": Fear, safety, and cultural stigma, and (3) "The circle … is not going to fix my life": LGBTQI+ migrants' call for affirming care. Results suggest that health and social care practices are stigmatizing and discriminatory which negatively impacts LGBTQI+ migrant mental health. Salient practices for promoting mental health included affirming LGBTQI+ identities and orientations through health and social care practices that are culturally safe as well as trauma and violence informed.
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Affiliation(s)
- Roya Haghiri-Vijeh
- School of Community and Health Studies, 58403Centennial College, Scarborough, ON, Canada
| | - Nancy Clark
- Faculty of Human and Social Development, School of Nursing, 175083University of Victoria, Victoria, BC, Canada
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de Vries JMA, Downes C, Sharek D, Doyle L, Murphy R, Begley T, McCann E, Sheerin F, Smyth S, Higgins A. An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:469-486. [PMID: 37901058 PMCID: PMC10601524 DOI: 10.1080/26895269.2022.2105772] [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: 10/31/2023]
Abstract
Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.
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Affiliation(s)
- Jan M. A. de Vries
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Danika Sharek
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Thelma Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward McCann
- Division of Nursing, City University of London, London, UK
| | - Fintan Sheerin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Siobhán Smyth
- School of Nursing and Midwifery, National University Galway, Galway, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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5
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Logie CH, Kinitz DJ, Gittings L, Persad Y, Lacombe-Duncan A, Poteat T. Eliciting critical hope in community-based HIV research with transgender women in Toronto, Canada: methodological insights. Health Promot Int 2022; 37:ii37-ii47. [PMID: 35213717 PMCID: PMC9226654 DOI: 10.1093/heapro/daac017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Critical hope centres optimism and possibilities for change in the midst of struggles for social justice. It was a central tenet of early participatory pedagogy and HIV research. However, critical hope has been overlooked in contemporary HIV research that largely focuses on risk and biomedical interventions in ways that obscure collective agency and community strengths. We conducted a community-based study with transgender (trans) women of colour in Toronto, Canada to adapt an evidence-based HIV prevention intervention. Participants resisted a focus on HIV, instead calling researchers to centre journeys to self-love in contexts of social exclusion. In response, we piloted three arts-based, participatory methods generated with community collaborators: (i) affirmation cards sharing supportive messages with other trans women, (ii) hand-held mirrors for reflecting and sharing messages of self-acceptance and (iii) anatomical heart images to visualize coping strategies. Participants generated solidarity and community through shared stories of self-acceptance within contexts of pain, exclusion and loss. Narratives revealed locating agency and self-acceptance through community connectedness. Critical hope was a by-product of this participatory process, whereby participants shared personal and collective optimism. Participatory and arts-based methods that centre self-acceptance and solidarity can nurture resistance to pathologizing discourses in HIV research. Centring critical hope and participant-generated methodologies is a promising approach to transformative health promotion and intervention research. These methodological insights can be engaged in future participatory work with other marginalized groups facing dominant biomedical risk discourses. Critical hope holds potential as a participatory health promotion strategy for envisioning possibilities for sustainable change.
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Affiliation(s)
| | - David J Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lesley Gittings
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Yasmeen Persad
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5G 1N8, Canada
- 519 Community Centre, Toronto, ON M4Y 2C9, Canada
| | - Ashley Lacombe-Duncan
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5G 1N8, Canada
- Faculty of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC 27599-7240, USA
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Poteat TC, Logie CH. A Case for Strengths-Based Approaches to Addressing Intersectional Stigma in HIV Research. Am J Public Health 2022; 112:S347-S349. [PMID: 35763726 PMCID: PMC9241452 DOI: 10.2105/ajph.2021.306659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tonia C Poteat
- Tonia C. Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada, and the Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Carmen H Logie
- Tonia C. Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada, and the Women's College Research Institute, Women's College Hospital, Toronto, Canada
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7
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Shelton SA, Lester AOS. A narrative exploration of the importance of intersectionality in a Black trans woman's mental health experiences. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:108-121. [PMID: 35403106 PMCID: PMC8986210 DOI: 10.1080/26895269.2020.1838393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color and LGBTQIA + communities. And although these numerous discriminatory policies and policy revisions have negatively affected both US people of color and LGBTQIA + people, trans women of color have been disproportionately affected. Even more specifically, when focusing on vulnerability to violence-including murder-it is Black trans women who are most directly affected by the intersections of transphobia and racism in the US. This article explores a Black trans woman's experiences with mental health professionals across two decades and different regions of the US. Aims: This article argues for the necessity of understanding trans people's mental health experiences as necessarily intersectional, in order to more fully appreciate and address the degrees to which factors such as race, socioeconomic class, and geographic context matter in trans people's efforts to access ethical and effective mental healthcare. Methods: Using a theoretical framework informed by Kimberlé Crenshaw's single-axis concept, the authors fully center Aryah's intersectional experiences and counter a single-axis in exploring trans mental health issues, our article relies on a narrative-based approach. As narrative inquiry is a broad field, we selected Butler-Kisber's narrative analytic approach, "Starting with the Story" as our method. The narratives are pulled from approximately 10 intensive qualitative interviews over the course of several months. Discussion: These narratives disrupt the common threads in the literature that ignore the degrees to which race and class matter alongside being a trans woman. In addition, as we noted that nearly all of the mental health literature relied on large-scale survey-based data, this article offers a qualitative narrative exploration of Aryah's experiences and works to humanize trans mental health challenges and needs, while emphasizing the multilayered oppressions and obstacles that affected Aryah.
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Affiliation(s)
- Stephanie Anne Shelton
- Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, Alabama, USA
- CONTACT Stephanie Anne Shelton Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Carmichael Hall 308, Box 870231, Tuscaloosa, AL35487, USA
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'I'm not interested in research; i'm interested in services': How to better health and social services for transgender women living with and affected by HIV. Soc Sci Med 2021; 292:114610. [PMID: 34923191 DOI: 10.1016/j.socscimed.2021.114610] [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] [Received: 12/23/2020] [Revised: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022]
Abstract
This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences. Notably, participants stressed the need for 1) trans-friendly and trans-specific services, 2) integrated health services, and aid in navigating complex, overlapping systems, and 3) comprehensive community-based services. They also suggest employing trans women as care coordinators or case managers in order to foster more trans-friendly environments and empower community members. We identify concrete ways to improve health and social services at the level of service delivery and program design, as well as recommendations for future participatory research. We close with an interrogation of trans people, and trans women living with and affected by HIV in particular, as 'hard to reach' populations.
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Teti M, Myroniuk T, Epping S, Lewis K, Liebenberg L. A Photovoice Exploration of the Lived Experience of Intersectional Stigma among People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3223-3235. [PMID: 34642838 DOI: 10.1007/s10508-021-02058-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
Stigma research among people living with HIV (PLWH) has been increasingly interpreted through the framework of intersectionality, which comprehends the interwovenness of vulnerable individuals' identities. However, community-based participatory methods have not been widely employed to better understand these forms of stigma through an intersectional lens, despite such methods offering the opportunity for participants to define issues and solutions from their lived experiences. To advance this research, we employed photovoice to elicit grounded, visceral definitions of stigma for PLWH. Participants took pictures representing their identities and experiences with HIV and other stigmas and discussed them in groups and individual interviews, ultimately creating a virtual exhibit to educate and inspire others. Theme and narrative analysis uncovered patterns in the visual and textual data, revealing participants' experiences of HIV stigma based on their intersections of sexuality, race/ethnicity, illness, and roles and expectations in specific scenarios. Stigma also fostered the development of participants' strengths, such as resiliency, and new identities, such as educators. Participatory methods like photovoice, where participants can define intersectionality on their own terms, can help direct interventions to limit the PLWH's lived stigmas and increase effective coping.
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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, 806 Lewis Hall, Columbia, MO, 65201, USA.
| | - Tyler Myroniuk
- Department of Public Health, University of Missouri, 806 Lewis Hall, Columbia, MO, 65201, USA
| | - Shane Epping
- Department of Public Health, University of Missouri, 806 Lewis Hall, Columbia, MO, 65201, USA
| | - Kaleea Lewis
- Department of Public Health, University of Missouri, 806 Lewis Hall, Columbia, MO, 65201, USA
| | - Linda Liebenberg
- Faculty of Graduate Studies, Dalhousie University, Halifax, NS, Canada
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10
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Barrington C, Davis DA, Gomez H, Donastorg Y, Perez M, Kerrigan D. "I've Learned to Value Myself More": Piloting an Adapted Multilevel Intervention for Transgender Women Sex Workers Living with HIV in the Dominican Republic. Transgend Health 2021; 6:148-155. [PMID: 34414270 DOI: 10.1089/trgh.2020.0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender (trans) women living with HIV experience suboptimal care and treatment outcomes. We adapted a multilevel intervention to improve HIV outcomes and overall well-being among trans women sex workers living with HIV. The intervention, called Abriendo Puertas (AP; Opening Doors), included: individual counseling, peer navigation, and community mobilization "open houses." The purpose of this article is to describe acceptability and initial outcomes of the adapted AP pilot and explore intervention experiences to inform recommendations for improvement. Methods: After an iterative adaptation process, we recruited 30 trans women sex workers living with HIV to participate in the pilot. We conducted baseline and endline (12-months) surveys to compare HIV care and treatment outcomes and qualitative interviews to assess intervention experiences with a subsample (n=20). Results: Intervention retention was high, with 86.7% of participants (n=26/30) completing both baseline and endline surveys. At endline, there was a significant increase in current anti-retroviral therapy (ART) use (70.0% to 84.6%, p<0.03) and positive, but not significant, trends in missed care appointments in the past 6 months (34.5% to 20.0%, p<0.39) and not having missed any ART doses in the past 4 days (85.7% to 95.5%, p<0.50). Intervention acceptability was high across all components: individual counseling (96.1%), peer navigation (80.8%), and open houses (84.6%). Participants emphasized that trust and being treated with respect allowed them to relax and improve their self-esteem. Limited trust and cohesion among trans women, however, limited more extensive engagement with peer navigation and community mobilization components. Conclusion: Future efforts to strengthen the AP intervention with trans women sex workers should continue to address emotional, instrumental, and informational support needs related to living with HIV through individual counseling, peer navigation, and open houses while also enhancing group-level activities to build trust and generate a collective commitment to promote the well-being of the community.
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Affiliation(s)
- Clare Barrington
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dirk A Davis
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hoisex Gomez
- HIV Vaccine and Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Huberto Bogaert Diaz, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine and Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Huberto Bogaert Diaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine and Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Huberto Bogaert Diaz, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- Milken Institute of Public Health, George Washington University, Washington, District of Columbia, USA
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11
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Abstract
PURPOSE OF REVIEW Transgender (trans) populations are heavily impacted by HIV, yet face structural, social, and individual barriers to engagement in HIV prevention and care. In this review, we summarize the data on barriers and facilitators and discuss evidence-informed strategies to facilitate access to and engagement in HIV prevention and care by trans communities. RECENT FINDINGS Intersectional stigma and discrimination at structural, community, individual levels present substantial impediments to HIV prevention and optimal care. Access to gender-affirming health care is a priority for trans communities. Where trans communities are highly networked, these networks may provide a strong infrastructure for disseminating HIV innovations and reaching individuals who are not engaged in HIV services. Efforts to engage trans people in HIV prevention and care must address stigma, provide gender-affirming services, and build on community strengths and priorities to ensure trans populations achieve maximum benefit from advances in HIV prevention and care. SUMMARY Combination approaches that respond to the complex drivers of HIV in trans communities represent promising strategies for engaging trans people and their partners in HIV prevention and care.
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Wirtz AL, Poteat T, Radix A, Althoff KN, Cannon CM, Wawrzyniak AJ, Cooney E, Mayer KH, Beyrer C, Rodriguez AE, Reisner SL. American Cohort to Study HIV Acquisition Among Transgender Women in High-Risk Areas (The LITE Study): Protocol for a Multisite Prospective Cohort Study in the Eastern and Southern United States. JMIR Res Protoc 2019; 8:e14704. [PMID: 31584005 PMCID: PMC6802485 DOI: 10.2196/14704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the United States, transgender women (TW) are disproportionately burdened by HIV infection. Cohort studies are needed to evaluate factors driving HIV acquisition among TW over time. These will require implementation strategies that are acceptable to the TW community and feasible to implement. OBJECTIVE This study aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern United States. METHODS LITE is a multisite prospective cohort in 6 eastern and southern US cities, which will be followed across 24 months of technology-enhanced biobehavioral follow-up. Adult TW, regardless of HIV status, are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants are enrolled in a baseline study visit, complete a sociobehavioral survey, and test for HIV and sexually transmitted infections. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1100); follow-up assessments occur quarterly. RESULTS Cohort assembly was informed by synchronous Web-based focus group discussions with TW (n=41) and by continuing engagement with community advisory board members from each site. Enrollment launched in March 2018. The study is underway in the Atlanta; Baltimore; Boston; Miami; New York City; and Washington, DC, metro areas. As of March 2019, 795 TW completed a baseline visit (mean age 35 years). The majority of the participants are racial/ethnic minorities, with 45% of the TW identifying as black and 28% of the TW identifying as Hispanic/Latinx. More than one-quarter (28%) of the TW are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, although peer referral and referral through trusted health facilities and organizations remain most effective. CONCLUSIONS This study is responsive to increasing research interest in technology-enhanced methods for cohort research, particularly for hard-to-reach populations. Importantly, the diversity of literacy, technology use, and overall socioeconomic situations in this sample of TW highlights the need to leverage technology to permit a flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14704.
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tonia Poteat
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sari L Reisner
- The Fenway Institute, Boston, MA, United States
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Pediatrics, 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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