Top

Published in:

01-12-2017 | Original Paper

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

Authors: Sari L. Reisner, Laura Jadwin-Cakmak, Jaclyn M. White Hughto, Miguel Martinez, Liz Salomon, Gary W. Harper

Published in: AIDS and Behavior | Issue 12/2017

Abstract

In the U.S., transgender and other gender minority (TG) youth are an at-risk group understudied in HIV prevention and treatment. This study sought to characterize the HIV prevention and care continua in a diverse sample of 181 sexually-active TG ages 16–24 years (mean age = 20.7 years; 76.8% trans feminine; 69.1% youth of color) recruited July–December 2015 in 14 U.S. cities. Overall, 30.9% reported living with HIV, of which 71.4% were on antiretroviral therapy (ART) and 55.0% were medication adherent; 65.6% were known to be virally suppressed. In multivariable models, medical gender affirmation was associated with lower odds of viral suppression. Medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. Among at-risk TG youth not living with HIV, only 8.2% had accessed pre-exposure prophylaxis (PrEP). Early biobehavioral prevention and treatment interventions are needed for TG youth.

Centers for Disease Control and Prevention. HIV Among Youth. 2016. https://www.cdc.gov/hiv/group/age/youth/. Accessed 25 Jan 2017.

McNairy ML, El-Sadr WM. A paradigm shift: focus on the HIV prevention continuum. Clin Infect Dis. 2014;59:S12–5. https://doi.org/10.1093/cid/ciu251.CrossRefPubMedPubMedCentral

Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV–United States, 2011. MMWR. 2014;63(47):1113–17.PubMed

Horn T, Sherwood J, Remien RH, Nash D, Auerbach J. Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model. J Int AIDS Soc. 2016;19(1):21263. https://doi.org/10.7448/ias.19.1.21263.

Health Resources and Services Administration. National HIV/AIDS Strategy for the United States: Updated to 2020. Washington; 2015.

Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Pat Care STDS. 2014;28(3):128–35. https://doi.org/10.1089/apc.2013.0345.CrossRef

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC; 2011. https://iom.nationalacademies.org/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx.

Shields JP, Cohen R, Glassman JR, Whitaker K, Franks H, Bertolini I. Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health. 2013;52(2):248–50. https://doi.org/10.1016/j.jadohealth.2012.06.016.CrossRefPubMed

Conron KJ, Landers SJ, Reisner SL, Sell RL. Sex and gender in the US health surveillance system: a call to action. Am J Public Health. 2014;104(6):970–6. https://doi.org/10.2105/AJPH.2013.301831.CrossRefPubMedPubMedCentral

10.

Flores A, Brown TM, Herman J. How Many adults identify as transgender in the United States. Los Angeles: Williams Institute UCLA School of Law; 2016.

11.

Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17. https://doi.org/10.1007/s10461-007-9299-3.CrossRefPubMed

12.

Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22. https://doi.org/10.1016/S1473-3099(12)70315-8.CrossRefPubMed

13.

Schulden JD, Song B, Barros A, et al. Rapid HIV testing in transgender communities by community-based organizations in three cities. Public Health Rep. 2008;3:101–14. https://doi.org/10.1177/00333549081230S313.CrossRef

14.

Reisner SL, Murchison GR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health. 2016;11(7–8):866–87. https://doi.org/10.1080/17441692.2015.1134613.CrossRefPubMedPubMedCentral

15.

Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS Behav. 2011;15(3):683–96. https://doi.org/10.1007/s10461-010-9773-1.CrossRefPubMed

16.

Scheim AI, Bauer GR, Travers R. HIV-related sexual risk among transgender men who are gay, bisexual, or have sex with men. JAIDS J Acquir Immune Defic Syndr. 2017;74(4):e89–e96. https://doi.org/10.1097/QAI.0000000000001222.CrossRefPubMed

17.

Rowniak S, Chesla C, Rose CD, Holzemer WL. Transmen: the HIV risk of gay identity. AIDS Educ Prev. 2011;23(6):508–20. https://doi.org/10.1521/aeap.2011.23.6.508.CrossRefPubMed

18.

Sevelius J. There’s no pamphlet for the kind of sex I have: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care. 2009;20(5):398–410. https://doi.org/10.1016/j.jana.2009.06.001.CrossRefPubMedPubMedCentral

19.

Reisner SL, Perkovich B, Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men. AIDS Patient Care STDS. 2010;24(8):501–13. https://doi.org/10.1089/apc.2010.0059.CrossRefPubMedPubMedCentral

20.

Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV infection in transgender adults and adolescents: results from the National HIV Surveillance System, 2009–2014. AIDS Behav. 2016. https://doi.org/10.1007/s10461-016-1656-7.

21.

Wilson EC, Chen Y-H, Arayasirikul S, et al. Differential HIV risk for racial/ethnic minority transfemale youths and socioeconomic disparities in housing, residential stability, and education. Am J Public Health. 2015;105:e41–7. https://doi.org/10.2105/AJPH.2014.302443.CrossRefPubMedPubMedCentral

22.

Reisner SL, Vetters R, White JM, et al. Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center. AIDS Care. 2015;27(8):1031–36. https://doi.org/10.1080/09540121.2015.1020750.CrossRefPubMedPubMedCentral

23.

Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adolesc Health. 2006;38(3):230–6. https://doi.org/10.1016/j.jadohealth.2005.03.023.CrossRefPubMed

24.

Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7. https://doi.org/10.2105/AJPH.2011.300433.CrossRefPubMedPubMedCentral

25.

Dowshen N, Matone M, Luan X, et al. Behavioral and health outcomes for HIV+ young transgender women (YTW) linked to and engaged in medical care. LGBT Heal. 2016;3(2):162–7. https://doi.org/10.1089/lgbt.2014.0062.CrossRef

26.

Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with Human Immunodeficiency Virus. Ann Behav Med. 2014;47(1):5–16. https://doi.org/10.1007/s12160-013-9565-8.CrossRefPubMedPubMedCentral

27.

Doshi RK, Milberg J, Isenberg D, et al. High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011. Clin Infect Dis. 2015;60(1):117–25. https://doi.org/10.1093/cid/ciu722.CrossRefPubMed

28.

Baguso GN, Gay CL, Lee KA. Medication adherence among transgender women living with HIV. AIDS Care. 2016;28(8):976–81. https://doi.org/10.1080/09540121.2016.1146401.CrossRefPubMedPubMedCentral

29.

Santos G-M, Wilson EC, Rapues J, Macias O, Packer T, Raymond HF. HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sex Transm Infect. 2014;90(5):430–3. https://doi.org/10.1136/sextrans-2013-051342.CrossRefPubMed

30.

Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412–36. https://doi.org/10.1016/S0140-6736(16)00684-X.CrossRefPubMed

31.

Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S235–42. https://doi.org/10.1097/QAI.0000000000001088.CrossRefPubMedPubMedCentral

32.

White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health. 2016;1(1):21–31.CrossRefPubMedPubMedCentral

33.

Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72(2):214–31. https://doi.org/10.1111/j.1365-2265.2009.03625.x.CrossRef

34.

Shumer DE, Nokoff NJ, Spack NP. Advances in the care of transgender children and adolescents. Adv Pediatr. 2016;63(1):79–102. https://doi.org/10.1016/j.yapd.2016.04.018.CrossRefPubMedPubMedCentral

35.

Olson J, Forbes C, Belzer M. Management of the transgender adolescent. Arch Pediatr Adolesc Med. 2011;165(2):111–28. https://doi.org/10.1001/archpediatrics.2010.275.CrossRef

36.

Olson-Kennedy J, Cohen-Kettenis PT, Kreukels BPC, et al. Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):172–9. https://doi.org/10.1097/MED.0000000000000236.CrossRefPubMedPubMedCentral

37.

Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016;19(7(Suppl 6)):21105. https://doi.org/10.7448/IAS.19.7.21105.PubMedPubMedCentral

38.

Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11–12):675–89. https://doi.org/10.1007/s11199-012-0216-5.CrossRefPubMed

39.

Deutsch MB, Glidden DV, Sevelius J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV. 2015;2(12):e512–9. https://doi.org/10.1016/S2352-3018(15)00206-4.CrossRefPubMedPubMedCentral

40.

Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychol Sex Orientat Gend Divers. 2016;3(3):336–44. https://doi.org/10.1037/sgd0000171.CrossRefPubMedPubMedCentral

41.

Reisner SL, White Hughto JM, Pardee D, Sevelius J. Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. Int J STD AIDS. 2015;11:955–66. https://doi.org/10.1177/0956462415602418.

42.

Radix A, Sevelius J, Deutsch MB. Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices. J Int AIDS Soc. 2016;19(3 Suppl 2):20810. https://doi.org/10.7448/IAS.19.3.20810.PubMedPubMedCentral

43.

Reisner SL, Pardo ST, Gamarel KE, White Hughto JM, Pardee DJ, Keo-Meier CL. Substance use to cope with stigma in healthcare among US female-to-male trans masculine adults. LGBT Heal. 2015;2(4):324–32. https://doi.org/10.1089/lgbt.2015.0001.CrossRef

44.

Reisner SL, White Hughto JM, Dunham EE, et al. Legal protections in public accommodations settings: a critical public health issue for transgender and gender-nonconforming people. Milbank Q. 2015;93(3):484–515. https://doi.org/10.1111/1468-0009.12127.CrossRefPubMedPubMedCentral

45.

White Hughto JM, Murchison GR, Clark K, Pachankis JE, Reisner SL. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Heal. 2016;3(6):424–33. https://doi.org/10.1089/lgbt.2016.0044.CrossRef

46.

White Hughto JM, Rose AJ, Pachankis JE, Reisner SL. Barriers to gender transition-related healthcare: identifying underserved transgender adults in Massachusetts. Transgender Health. 2017;2(1):107-118. https://doi.org/10.1089/trgh.2017.0014.CrossRefPubMedPubMedCentral

47.

Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22–9. https://doi.org/10.1016/j.socscimed.2013.02.019.CrossRefPubMed

48.

Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51. https://doi.org/10.2105/AJPH.2013.301241.CrossRefPubMedPubMedCentral

49.

White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31. https://doi.org/10.1016/j.socscimed.2015.11.010.CrossRefPubMedPubMedCentral

50.

Rowe C, Santos G-M, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area. Drug Alcohol Depend. 2015;147:160–6. https://doi.org/10.1016/j.drugalcdep.2014.11.023.CrossRefPubMed

51.

Hotton AL, Garofalo R, Kuhns LM, Johnson AK. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women. AIDS Educ Prev. 2013;25(1):62–71. https://doi.org/10.1521/aeap.2013.25.1.62.CrossRefPubMed

52.

Centers for Disease Control and Prevention. HIV Among Transgender People 2016. https://www.cdc.gov/hiv/group/gender/transgender/. Accessed 25 Jan 2017.

53.

Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Prof Psychol Res Pract. 2012;43(5):460–7. http://dx.doi.org/10.1037/a0029597.CrossRef

54.

Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13(1):482. https://doi.org/10.1186/1471-2458-13-482.CrossRefPubMedPubMedCentral

55.

Israel BA, Krieger J, Vlahov D, et al. Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle Urban Research Centers. J Urban Health. 2016;83(6):1022–40. https://doi.org/10.1007/s11524-006-9110-1.CrossRef

56.

Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006;7(3):312–23. https://doi.org/10.1177/1524839906289376.CrossRefPubMed

57.

Reisner S, Keatley J, Baral S, et al. Transgender community voices: a participatory population perspective. Lancet. 2016;388(10042):327–30. https://doi.org/10.1016/S0140-6736(16)30709-7.CrossRefPubMed

58.

Harper GW, Willard N, Ellen JM. Adolescent Medicine Trials Network for HIV/AIDS Interventions. Connect to Protect^®: utilizing community mobilization and structural change to prevent HIV infection among youth. J Prev Interv Commun. 2012;40(2):81–6. https://doi.org/10.1080/10852352.2012.660119.CrossRef

59.

Siskind RL, Andrasik M, Karuna ST, et al. Engaging transgender people in NIH-funded HIV/AIDS clinical trials research. J Acquir Immune Defic Syndr 2016;72(Suppl 3):S243–7. https://doi.org/10.1097/QAI.0000000000001085.CrossRefPubMedPubMedCentral

60.

Reisner SL, Conron KJ, Tardiff LA, Jarvi S, Gordon AR, Austin SB. Monitoring the health of transgender and other gender minority populations: validity of natal sex and gender identity survey items in a US national cohort of young adults. BMC Public Health. 2017;14:1224. https://doi.org/10.1186/1471-2458-14-1224.CrossRef

61.

Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;153(6):591–6.CrossRefPubMed

62.

Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156(6):607–14.CrossRefPubMed

63.

Hosek SG, Harper GW, Domanico R. Predictors of medication adherence among HIV-infected youth. Psychol Health Med. 2005;10(2):166–79. https://doi.org/10.1080/1354350042000326584.CrossRef

64.

Sikkema KJ, Hansen NB, Kochman A, et al. The development and feasibility of a brief risk reduction intervention for newly HIV-diagnosed men who have sex with men. J Commun Psychol. 2011;39(6):717–32. https://doi.org/10.1002/jcop.20463.CrossRef

65.

Harper GW, Jadwin-Cakmak L, Reisner S et al. Exploring utilization of HIV-related services and care among transgender and other gender minority youth in the U.S. National Transgender Health Summit, Oakland; 2015.

66.

Hosmer DJ, Lemeshow SSR. Applied logistic regression. Hoboken: Wiley; 2013.CrossRef

67.

Ferrand RA, Briggs D, Ferguson J, et al. Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges. Trop Med Int Health. 2016;21(3):325–33. https://doi.org/10.1111/tmi.12656.CrossRefPubMedPubMedCentral

68.

Agwu AL, Fleishman JA, Korthuis PT, et al. Disparities in antiretroviral treatment: a comparison of behaviorally HIV-infected youth and adults in the HIV Research Network. J Acquir Immune Defic Syndr. 2011;58(1):100–7. https://doi.org/10.1097/QAI.0b013e31822327df.CrossRefPubMedPubMedCentral

69.

Althoff KN, Rebeiro P, Brooks JT, et al. Disparities in the quality of HIV care when using US department of health and human services indicators. Clin Infect Dis. 2014;58(8):1185–9. https://doi.org/10.1093/cid/ciu044.CrossRefPubMedPubMedCentral

70.

Ulett KB, Willig JH, Lin H-Y, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9. https://doi.org/10.1089/apc.2008.0132.CrossRefPubMedPubMedCentral

71.

Whiteside YO, Cohen SM, Bradley H, et al. Progress along the continuum of HIV care among blacks with diagnosed HIV- United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(5):85–9.PubMed

72.

Kann L, McManus T, Harris W, et al. Youth Risk Behavior Surveillance-United States, 2013. Morbidity and Mortality Weekly Report. 2014;63:SS-4.

73.

Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr 2008;48(1):97–103. https://doi.org/10.1097/QAI.0b013e31816e3971.CrossRefPubMed

74.

Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86. https://doi.org/10.1016/S0140-6736(14)60833-3.CrossRefPubMed

75.

UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva; 2014.

76.

Stone VE. Optimizing the care of minority patients with HIV/AIDS. Clin Infect Dis. 2004;38(3):400–4. https://doi.org/10.1086/380969.CrossRefPubMed

77.

Greifinger R, Batchelor M, Fair C. Improving engagement and retention in adult care settings for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth living with HIV: recommendations for health care providers. J Gay Lesbian Ment Health. 2013;17(1):80–95. http://dx.doi.org/10.1080/19359705.2013.739533.CrossRef

78.

Bauer GR, Scheim AI. Sampling bias in transgender studies. Lancet Infect Dis. 2013;13(10):832. https://doi.org/10.1016/S1473-3099(13)70242-1.CrossRefPubMed

Title: Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.
Authors: Sari L. Reisner
Laura Jadwin-Cakmak
Jaclyn M. White Hughto
Miguel Martinez
Liz Salomon
Gary W. Harper
Publication date: 01-12-2017
Publisher: Springer US
Published in: AIDS and Behavior / Issue 12/2017
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-017-1938-8

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2017

Impact of Food Insecurity on Depressive Symptoms Among HIV–HCV Co-infected People

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions

Mental Health Disorders and Publicly Funded Service Use by HIV Positive Individuals: A Population-Based Cross-Sectional Study in Ontario, Canada

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

Food Insecurity and Aging Outcomes in Older Adults Living with HIV

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page