Welcome to the BATLab’s Weekly Lit Review, where every week we post peer-reviewed papers relevant to our research projects.
This week, take a look at this interesting paper published in the Journal of Adolescent Health in 2016:
Key words: HIV care, Transgender women, HIV prevention, HIV Testing
Young transgender women (YTW) face many challenges to their physical and emotional well-being and alarming rates of HIV infection, reported to be approximately 25% according to a recent meta-analysis. Among transgender individuals the prevalence of mental health challenges including depression and anxiety have been estimated to be as high as 62%, and recent data also show that youth in general have worse health outcomes along the HIV care continuum when compared to adults, including low rates of diagnosis, linkage and retention in care, antiretroviral therapy (ART) prescription and viral suppression. The purpose of this study was to understand factors that affect engagement in prevention services (routine HIV/STI testing and PrEP) for HIV-negative or status unknown YTW, and linkage, retention and treatment adherence for HIV+ YTW.Methods
We conducted a mixed methods study of individuals aged 16-24 who were born assigned male sex, but identify as female and reported anal sex with a male partner in the last year. Participants were recruited from an adolescent HIV clinic, through local AIDS services organizations that serve YTW and social media. The study consisted of (1) a computer-assisted self interview (CASI) including demographics, mental health measures, and sexual health behavior, (2) qualitative semi-structured interview, (3) optional rapid HIV testing for HIV negative or status unknown participants, and (4) chart review to determine rates of ART prescription and viral suppression.
Participants (N=20) were HIV+ (N=6) and HIV-/status unknown (N=14) YTW, mean age 21 (SD 2.35), 30% AA, 30% white, 40% biracial/other, 20% Hispanic, 75% less than college education, 45% unemployed, 25% unstably housed, 80% income < $12,000/yr, and 40% uninsured. 50% of participants used condoms at last sexual intercourse and 33% of those using hormones for gender transition obtained them from a source other than a prescription by a medical provider. Of those youth who were HIV+ (N=6) 50% were prescribed ART and of those on ART 100% achieved viral suppression (viral load < 200). The key themes that emerged from qualitative interviews were as follows: (1) social support from family, friends, and support groups and connecting with a medical provider who was knowledgeable about trans health were facilitators to engaging in services across the HIV care continuum, (2) lack of respect for identity in the form of not using preferred names or pronouns and lack of providers or staff in health care organizations that reflect the transgender community are significant barriers to engagement in care, and (3) resilience despite the challenges of stigma and resulting mental health problems including depression and anxiety is key to achieving health goals.
Identifying barriers and facilitators to care for young transgender women may inform intervention development and policy change to improve medical and mental health care for this marginalized population along the HIV care continuum.
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