Transgender women and HIV-related health disparities: falling off the HIV treatment cascade

Sexual Health ◽  
2017 ◽  
Vol 14 (5) ◽  
pp. 469 ◽  
Author(s):  
Seth C. Kalichman ◽  
Dominica Hernandez ◽  
Stephanie Finneran ◽  
Devon Price ◽  
Redd Driver
Keyword(s):  
Social Support ◽  
Health Disparities ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Treatment Cascade ◽  
Women Living With Hiv ◽  
Hiv Treatment Cascade ◽  
Hiv Viral Suppression ◽  
Hiv Continuum Of Care ◽  
Living With Hiv

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.

Social Support, Positive States of Mind, and HIV Treatment Adherence in Men and Women Living With HIV/AIDS.

2004 ◽  
Vol 23 (4) ◽  
pp. 413-418 ◽  
Author(s):  
Jeffrey S. Gonzalez ◽  
Frank J. Penedo ◽  
Michael H. Antoni ◽  
Ron E. Durán ◽  
Shvawn McPherson-Baker ◽  
...  
Keyword(s):  
Social Support ◽  
Treatment Adherence ◽  
Hiv Treatment ◽  
States Of Mind ◽  
Men And Women ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

Overview of Factors Associated with HIV Viral Load Suppression in Transgender Women

2020 ◽  
Author(s):  
Zil G Goldstein
Keyword(s):  
Viral Load ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Treatment Cascade ◽  
Factors Associated ◽  
The World ◽  
Hiv Treatment Cascade ◽  
Almost All

Abstract Background Transgender women face a significantly higher HIV burden than their cisgender counterparts around the world with worse treatment outcomes in almost all categories. Content A mini-review of the available literature discussing HIV risk and factors associated with HIV viral load suppression in transgender women. Summary This review discusses the disparities transgender women face that contribute to both of these factors including race as well as social determinants of health and how they affect the HIV treatment cascade in this population.

scholarly journals The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons

2019 ◽  
Vol 30 (13) ◽  
pp. 1257-1264 ◽  
Author(s):  
Nima Ghalehkhani ◽  
Behnam Farhoudi ◽  
Mohammad Mehdi Gouya ◽  
Hamid Sharifi ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Cell Count ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Treatment Cascade ◽  
Cascade Analysis ◽  
Hiv Treatment Cascade ◽  
Living With Hiv ◽  
Cd4 Cell

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

scholarly journals An Intervention by and for Transgender Women Living With HIV: Study Protocol for a Two-Arm Randomized Controlled Trial Testing the Efficacy of “Healthy Divas” to Improve HIV Care Outcomes

2021 ◽  
Vol 3 ◽  
Author(s):  
Jae M. Sevelius ◽  
Torsten B. Neilands ◽  
Cathy J. Reback ◽  
Danielle Castro ◽  
Samantha E. Dilworth ◽  
...  
Keyword(s):  
Social Services ◽  
San Francisco ◽  
Controlled Trial ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Randomized Controlled ◽  
Women Living With Hiv ◽  
Institutional Review ◽  
Living With Hiv

Introduction: Transgender women (assigned “male” at birth but who do not identify as male) are disproportionately impacted by HIV and experience unique barriers and facilitators to HIV care engagement. In formative work, we identified culturally specific and modifiable barriers to HIV treatment engagement among transgender women living with HIV (TWH), including prioritizing transition-related healthcare over HIV treatment, avoiding HIV care settings due to gender-related and HIV stigma, concerns about potential drug interactions with hormones, and inadequate social support. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, we developed the Healthy Divas intervention to optimize engagement in HIV care among TWH at risk for treatment failure and consequential morbidity, mortality, and onward transmission of HIV.Methods and Analysis: We conducted a 2-arm randomized controlled trial (RCT) of the intervention's efficacy in Los Angeles and San Francisco to improve engagement in care among TWH (N = 278). The primary outcome was virologic control indicated by undetectable HIV-1 level (undetectability = < 20 copies/mL), at baseline and follow-up assessment for 12 months at 3-month intervals.Ethics and Dissemination: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Western Institutional Review Board (20181370). Participants provided informed consent before enrolment in the study. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. We will make our results available to researchers interested in transgender health to avoid unintentional duplication of research, as well as to others in health and social services communities, including HIV clinics, LGBT community-based organizations, and AIDS service organizations.Clinical Trial Registration:Clinicaltrials.gov, identifier NCT03081559.

Early stages of HIV treatment cascade in people living with HIV in Saint-Petersburg, Russia

AIDS Care ◽  
2018 ◽  
Vol 30 (7) ◽  
pp. 857-862 ◽  
Author(s):  
M. V. Vetrova ◽  
O. V. Aleksandrova ◽  
A. E. Paschenko ◽  
S. E. Toropov ◽  
V. V. Rassokhin ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
People Living With Hiv ◽  
Treatment Cascade ◽  
Saint Petersburg ◽  
Early Stages ◽  
Hiv Treatment Cascade ◽  
Living With Hiv

scholarly journals Problematizing transitions in relation to correctional centres for people living with HIV: Unpacking the taken for granted.

2021 ◽  
Vol 3 (2) ◽  
pp. 47-63
Author(s):  
Morgan Wadams
Keyword(s):  
Healthcare Providers ◽  
Hiv Treatment ◽  
Knowledge Generation ◽  
Hiv Care ◽  
Correctional Facilities ◽  
People Living With Hiv ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade ◽  
Care Practices ◽  
Living With Hiv

Transitions into and out of correctional facilities for people living with HIV are a pivotal point in the HIV treatment cascade where adherence metrics are significantly affected. In this paper I use Alvesson and Sandberg’s problematization method of literature analysis to critique and understand the taken-for-granted assumptions underpinning how knowledge is generated within the intersecting fields of HIV, transitions, and corrections. Utilizing problematization, two assumptions underpinning knowledge generation are identified: the linearity of the HIV care continuum model and the tendency to create and perpetuate spatially segregating metaphors of transitions inside versus outside correctional facilities for people living with HIV. These assumptions are discussed in the context of how they shape dominant ways of thinking and practicing in the field. An alternative way to understand transitions for people living with HIV is proposed along with recommendations to guide the HIV care practices of nurses and other healthcare providers.

HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study

2014 ◽  
Vol 90 (5) ◽  
pp. 430-433 ◽  
Author(s):  
Glenn-Milo Santos ◽  
Erin C Wilson ◽  
Jenna Rapues ◽  
Oscar Macias ◽  
Tracey Packer ◽  
...  
Keyword(s):  
San Francisco ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Respondent Driven Sampling ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade
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