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Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California

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Abstract

Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65–0.93, Z = − 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51–0.83, Z = − 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44–0.87, Z = − 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63–0.98, Z = − 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41–0.86, Z = − 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.

Resumen

Persisten disparidades preocupantes en la supresión viral entre las mujeres transgénero (trans) que viven con el VIH en los EE. UU. Utilizamos datos de referencia de un ensayo controlado aleatorizado de una intervención conductual entre mujeres trans que viven con el VIH en San Francisco y Los Ángeles, para identificar los correlatos socioecológicos de la supresión viral confirmada biológicamente (< 200 copias/ml de ARN del VIH-1). Entre 253 participantes, la edad media fue de 43 años (DE = 11), el 46% se identificó como negro o afroamericano y el 35% no tenía supresión viral. En modelos de regresión de Poisson ajustados, se identificaron las siguientes barreras para la supresión viral: uso de drogas inyectables [razón de riesgo ajustada (aRR) 0,78, IC del 95% 0,65–0,93, Z = − 2,64, p = 0,008], uso de metanfetamina (aRR 0,65, IC 95% 0,51–0,83, Z = − 3,45, p = 0,001), consumo de anfetaminas (aRR 0,62, IC 95% 0,44–0,87, Z = − 2,75, p = 0,006), falta de vivienda (aRR 0,79, IC 95% 0,63–0,98, Z = − 2,06, p = 0,039), y trabajo sexual (aRR 0,60, IC 95% 0,41–0,86, Z = − 2,77, p = 0,009). Estos hallazgos subrayan la importancia de las intervenciones que abordan las barreras socioecológicas para la supresión viral entre las mujeres trans en entornos urbanos.

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Data Availability

Due to the sensitive nature of the data collected and the vulnerable nature of our study participants, data are available upon request. Formal data requests may be sent to the UCSF Committee on Enterprise Information and Analytics (contact via datasharing@ucsf.edu. In addition, the principal investigator Dr. Jae Sevelius will happily assist with any efforts to replicate our study findings for researchers who meet criteria for data access.

Code Availability

The code used for the statistical analyses presented in this manuscript are also available upon request. The corresponding author, Dr. Jennifer P. Jain will gladly facilitate access to her code for those who meet the criteria for code access.

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Acknowledgements

We gratefully acknowledge our study participants and research staff who made this research possible. We would also like to acknowledge our funding agencies including the National Institute of Drug Abuse for their support of Dr. Jain (1K01DA056306-01; T32DA007250-28) and Dr. Sevelius (K24DA051328), and the National Institute of Mental Health (R01MH106373, PI: Sevelius) for funding the parent study. Dr. Reback acknowledges additional support from the National Institute of Mental Health (P30MH58107).

Funding

This work was supported by the National Institute on Drug Abuse (Grant Nos. T32DA007250-28; 1K01DA056306-01; K24DA051328) and the National Institute of Mental Health (Grant Nos. R01MH106373; P30MH58107).

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Authors and Affiliations

  1. Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA

    Jennifer P. Jain & Glenn-Milo Santos

  2. Department of Medicine, University of California, San Francisco, San Francisco, USA

    Miranda Hill, Mallory O. Johnson, Torsten B. Neilands, Samantha E. Dilworth & Jae Sevelius

  3. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA

    Kristi E. Gamarel

  4. Friends Research Institute, Los Angeles, CA, USA

    Cathy J. Reback

  5. Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA

    Cathy J. Reback

  6. Department of Psychiatry, Columbia University, New York, USA

    Jae Sevelius

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Contributions

Conception of study design: JPJ, JS and KEG. Data analysis and interpretation: JPJ and TBN. Drafting the article: JPJ, KEG and MH. Critical revision of the article: JPJ, MH, KEG, G-MS, TBN, SD, MOJ, CJR and JS. Final approval of the version published: JPJ, MH, KEG, G-MS, TBN, SD, MOJ, CJR and JS.

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Correspondence to Jennifer P. Jain.

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Jain, J.P., Hill, M., Gamarel, K.E. et al. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 27, 2523–2534 (2023). https://doi.org/10.1007/s10461-023-03979-4

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