Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.
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.
KeywordsTransgender HIV Prevention Adolescents
We would also like to thank the following individuals, groups, and entities for their contributions to this study: Elliot Popoff and Bré Anne Campbell, University of Michigan research staff who made this study possible. The investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Straub, Bruce, Kerr), Children’s Hospital of Los Angeles (Belzer, Tucker, Franco), Children’s National Medical Center (D’Angelo, Trexler, Carr, Sinkfield), Children’s Hospital of Philadelphia (Douglas, Tanney, DiBenedetto, Franklin, Smith), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Henry-Reid, Bojan, Balthazar), Montefiore Medical Center (Futterman, Campos, Wesp, Nazario, Reopell), Tulane University Health Sciences Center (Abdalian, Kozina, Baker, Wilkes), University of Miami School of Medicine (Friedman, Maturo), St. Jude’s Children’s Research Hospital (Gaur, Flynn, Dillard, Hurd-Sawyer), Baylor College of Medicine (Paul, Head, Sierra), Wayne State University (Secord, Cromer, Walters, Houston), Johns Hopkins University (George-Agwu, Anderson, Worrel-Thorne), Fenway Institute (Mayer, Dormitzer, Massaquoi, Gelman), University of Colorado Denver (Reirden, Hahn, Bernath). Network, scientific and logistical support was provided by the ATN Coordinating Center (C. Wilson, C. Partlow) at The University of Alabama at Birmingham and the ATN 130 protocol team. Network operations and data management support was provided by the ATN Data and Operations Center at Westat, Inc. (G. Price). The authors are grateful to the members of the Affirming Voices for Action (AVA) Youth Advisory Board for their insight and guidance. We would like to thank the trans* youth who raised their voices and shared their experiences with us. We hear you.
Compliance with Ethical Standards
All study activities were approved at the Institutional Review Boards at the 14 Adolescent Medicine Trials Unit (AMTU) sites, as well as investigators’ institutions.
Conflicts of interest
The authors have no relevant conflicts of interest to disclose.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Boards at the 14 participating sites, as well as with the investigators’ institutions, including with the 1964 Helsinki Declaration and its later amendments and ethical standards.
Informed consent was obtained from all individuals participants included in the study.
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