Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV

  • Jae SeveliusEmail author
  • Deepalika Chakravarty
  • Torsten B. Neilands
  • JoAnne Keatley
  • Starley B. Shade
  • Mallory O. Johnson
  • Greg Rebchook
  • HRSA SPNS Transgender Women of Color Study Group


Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.


Transgender HIV Gender affirmation Healthcare empowerment Viral suppression 



This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U90HA24973 in the amount of $536,244 awarded to the University of California at San Francisco. No percentage of this project was financed with non-governmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. We would also like to thank our participants and the survey administration staff at each of the demonstration sites. Dr. Johnson’s contribution to this manuscript was supported by NIDA K24DA037034.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jae Sevelius
    • 1
    • 2
    Email author
  • Deepalika Chakravarty
    • 1
    • 3
  • Torsten B. Neilands
    • 1
  • JoAnne Keatley
    • 2
  • Starley B. Shade
    • 1
    • 4
  • Mallory O. Johnson
    • 1
  • Greg Rebchook
    • 1
    • 2
  • HRSA SPNS Transgender Women of Color Study Group
  1. 1.Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSFUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Medicine, Center of Excellence for Transgender HealthUniversity of CaliforniaSan FranciscoUSA
  3. 3.Center for Research and Education on Gender and SexualitySan Francisco State UniversitySan FranciscoUSA
  4. 4.Department of Epidemiology and Biostatistics, Institute for Global Health SciencesUniversity of CaliforniaSan FranciscoUSA

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