The review of continued medical care finds that 80% of transgender women in medical care achieve an undetectable viral load.
June 27, 2019 • By Liz Highleyman
According to a recent study, transgender women are less likely to start and stay on HIV care than women and (non-trans) men, but if they do, they have the same chance of achieving viral suppression on antiretroviral therapy.
Throughout the epidemic, finding good data on HIV among transgender people has been difficult, in part because trans people have often been excluded from research or categorized according to their gender assignment at birth (for example, trans women categorized as “men who have sex with men”). Nevertheless, experts estimate that approximately one in five transgender people in the United States are living with HIV, with trans women accounting for the majority of these cases.
Numerous previous studies have shown that transgender women have worse health outcomes than cisgender women and men, which is linked to a range of factors from poverty and stigma to lack of insurance and inadequate healthcare. Transgender women have one of the highest rates of new HIV infections, and some research has found that transgender women living with HIV are less likely to receive care and achieve viral suppression. One study, for example, found that most HIV-positive transgender women were diagnosed with AIDS within three months of their HIV diagnosis, indicating a delay in testing and access to care. But these studies have generally been small, and participants have only been observed at a single point in time.
As described in a report in Clinical Infectious Diseases, Tonia Poteat, PhD, MPH, of the University of North Carolina at Chapel Hill, and her colleagues, therefore, sought to characterize the continuum of HIV care over time, comparing transgender women, cisgender women, and cisgender men between January 2001 and December 2015. Continuity of care refers to the successive steps from HIV testing and diagnosis to linking care with the initiation of antiretroviral treatment to achieve an undetectable viral load.
This retrospective analysis examined the medical records of the North American AIDS Cohort Collaboration for Research and Design (NA-ACCORD), the largest ongoing cohort study of people with HIV in the United States and Canada. Among the more than 20 cohorts that make up NA-ACCORD, 15 cohorts were able to provide data on transgender participants; this group was dubbed the North American Transgender Cohort Collaboration, or NA-TRACC.
In total, the study population included 396 transgender women, 14,094 women, and 101,667 men. Transgender women included participants who took feminizing hormones or identified as female in medical records. This analysis did not include the 38 transgender men or two intersex individuals identified in the study population.
Transgender women were younger, on average, than women and men (median age 36, 40, and 44, respectively). By race/ethnicity, 40% of transgender women were Black, the group with the highest incidence of HIV, as were 56% of women and 36% of men. Transgender women were more than twice as likely to be Latina as women and men (21%, 7%, and 9%, respectively). Only 8% of transgender women reported injecting drug use, compared to approximately 20% of women and men.
Poteat's team found that a smaller proportion of transgender women remained in HIV care compared to women or men. What's more, transgender women's retention in care was consistently lower and did not change much over time.
However, among those who remained in care, a similar proportion of transgender women and women achieved viral suppression. All three groups showed substantial improvement in viral suppression over time. In 2015, 80% of transgender women in care had undetectable viral loads, compared to only 36% in 2001. Among women, the proportion increased from 35% in 2001 to 83% in 2015.
A higher proportion of men had viral suppression at both time points, although the magnitude of the increase was similar, rising from 41% to 87%. After adjusting for confounding factors, such as age, race/ethnicity, and HIV risk category, the differences between the groups were not statistically significant, meaning they could have been driven by chance.
“Transgender women experience challenges with retention in HIV care,” the study authors concluded. “However, transgender women who participate in medical care achieve viral suppression comparable to cisgender women and cisgender men of similar age, race, and HIV risk group.”
These findings highlight the importance of better understanding the disparities in access to care between transgender women and cisgender people and developing tailored programs to address these inequalities.
"Specific barriers for transgender people to participate in care include fear of disclosure of transgender identity, mistreatment by staff such as using inappropriate name or pronoun, and lack of provider knowledge about transgender health," the researchers wrote.
Some research suggests that trans women who receive HIV and gender-affirming care, such as hormones, from the same provider are more likely to be treated.
"Emerging information confirms that transgender women frequently prioritize gender-affirming care over other health issues, and meeting the gender-affirming needs of transgender women living with HIV may be an effective way to improve care engagement," Poteat's team suggested.
From: https://www.poz.com/article/engaged-care-trans-women-high-rates-hiv-suppression
Once Engaged in Care, Trans Women Have High Rates of HIV Suppression