Despite the high HIV burden among transgender women, access to health care among this demographic is low due to structural barriers that limit access to HIV prevention, testing, care, and other health services. Therefore, transgender women have been identified as a priority population in the Ending the HIV Epidemic in the U.S. (EHE) plan and National HIV/AIDS Strategy.
In this study, a multisite cohort was used to estimate HIV incidence in 1,312 transgender women in the eastern and southern regions of the United States. This approach allowed for monitoring epidemic trends, identifying drivers of HIV acquisition, and assessing if and how national health policies and HIV prevention efforts, including new pre-exposure prophylaxis (PrEP) modalities, affect HIV epidemic trends. The multisite cohort was established across two modes: 1) a site-based, technology-enhanced mode in six cities and 2) an exclusively digital mode that covered 72 cities. An advantage of including both a site-based and a digital mode is that it allowed for testing of the digital divide concept. For example, participants with technology access may have higher levels of education and few economic vulnerabilities, factors that have been associated with lower HIV incidence rates in previous studies. Adult transwomen (≥18 years) who were not living with HIV were eligible for inclusion and were followed up for at least 24 months, with some participants re-enrolling for an additional 3 years. Participants completed surveys and oral fluid HIV testing with clinical confirmation.
The findings of this study revealed that HIV incidence was higher in the site-based mode than in the digital mode. Paired with the finding that inconsistent access to communication technology was also associated with incidence rates, the study supports the digital divide concept. Experiences and characteristics associated with HIV incidence included race, self-reported history of sexually transmitted infection, stimulant use, telephone disconnection, number of recent sexual partners, PrEP indication, and partner PrEP use. Even though digital and telehealth options have become increasingly common, community and location-based efforts are still needed to reach the most marginalized transgender women. Structural, individual-level, and substance use interventions may be instrumental in improving access to various health services, including HIV prevention and mental and behavioral health services.
References:
Wirtz, AL et al. HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study. Lancet HIV. DOI 10.1016/S2352-3018(23)00008-5