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
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.
KeywordsTransgender 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.
- 2.James SE, et al. The report of the 2015 US transgender survey. Washington, DC: National Center for Transgender Equality; 2016.Google Scholar
- 12.Nuttbrock L, Rosenblum A, Blumenstein R. Transgender identity affirmation and mental health. Int J Transgenderism, 2002;6(4).Google Scholar
- 14.Sevelius J, Johnson M. Preliminary support for transgender-specific predictors of uptake and adherence to ART and viral load among HIV+ transgender women. In: 8th international conference on HIV treatment and prevention adherence. International Association of Providers in AIDS Care; 2013.Google Scholar
- 15.Sevelius J, Johnson M. A qualitative investigation of barriers to treatment initiation and engagement among transgender women living with HIV. In: 8th international conference on HIV treatment and prevention adherence. Miami Beach: International Association of Providers in AIDS Care; 2013.Google Scholar
- 24.SAS Institute. SAS on-line doc version 9.0. Cary: SAS Institute Inc.; 2002.Google Scholar
- 25.Muthén LK, Muthén BO. MPlus software. Muthén & Muthén: Los Angeles; 1998-2017.Google Scholar
- 28.Bollen KA, Long JS. Introduction. Testing structural equation models. Newbury Park: Sage Publications; 1993. p. 1–9.Google Scholar
- 31.Yu CY. Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes, in [Doctoral Dissertation]. Los Angeles: University of California; 2002.Google Scholar