Transgender women and HIV-related health disparities: falling off the HIV treatment cascade
Seth C. Kalichman A B , Dominica Hernandez A , Stephanie Finneran A , Devon Price A and Redd Driver A
+ Author Affiliations
- Author Affiliations
A Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269.
B Corresponding author. Email: seth.k@uconn.edu
Sexual Health 14(5) 469-476 https://doi.org/10.1071/SH17015
Submitted: 28 January 2017 Accepted: 18 May 2017 Published: 5 September 2017
Abstract
Background: Transgender women living with HIV infection experience poorer health outcomes across the HIV continuum of care. While disparities are well established, their underlying mechanisms are not well understood. This study examined the HIV continuum of care (also known as the HIV treatment cascade), including linkage and engagement in care and health status among transgender women and cisgender women and cisgender men living with HIV. Method: Case-control matching was applied to a cohort of 1101 people living with HIV; 70 transgender women living with HIV were matched on years since testing HIV positive with cisgender women and cisgender men. Participants provided measures indicative of the HIV treatment cascade that included linkage and engagement in care, receiving and adhering to antiretroviral therapy (ART), and HIV viral suppression. Common correlates of HIV-related health status: depression symptoms, HIV-related stress, alcohol and drug use, healthcare conspiracy beliefs, medical mistrust, emotional social support and tangible social support, were also assessed. Results: Transgender women were significantly less likely to receive ART, were less adherent to ART and had poorer HIV viral suppression than cisgender persons. Multivariable models demonstrated that health disparities were predicted by transgender women having poorer tangible social support over and above the other correlates of health outcomes. Conclusion: Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.
Additional keywords: HIV infection, HIV treatment, linkage to care, adherence, care continuum.
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