Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study
Ashley Lacombe-Duncan A B I , Peter A. Newman B , Greta R. Bauer C , Carmen H. Logie B D , Yasmeen Persad D , Mostafa Shokoohi C , Nadia O’Brien E F , Angela Kaida G , Alexandra de Pokomandy E F and Mona Loutfy D H
+ Author Affiliations
- Author Affiliations
A School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, Michigan 48109-1106, USA.
B Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
C Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Kresge Building, London, Ontario N6A 5C1, Canada.
D Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
E Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
F Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada.
G Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
H Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
I Corresponding author. Email: lacombed@umich.edu
Sexual Health 16(4) 367-376 https://doi.org/10.1071/SH19011
Submitted: 23 January 2019 Accepted: 21 March 2019 Published: 9 July 2019
Abstract
Background: Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.
Additional keywords: gender affirmation, stigma.
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