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Antiretroviral Treatment Interruptions Among Black and Latina Transgender Women Living with HIV: Characterizing Co-occurring, Multilevel Factors Using the Gender Affirmation Framework

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Abstract

Black and Latina transgender women (BLTW) are disproportionately impacted by HIV but remain underrepresented in HIV and health services research. Between March 2016 and May 2017, BLTW (N = 201) were recruited in Baltimore, Maryland and Washington, DC through convenience sampling for a survey assessing multilevel determinants of HIV risk and treatment outcomes. Interviews concluded with a rapid oral HIV test. Bivariate and multivariable logistic regression modeling was performed to identify gender affirmation-related correlates of self-reported HIV treatment interruptions (HIVTIs) among BLTW living with HIV who had initiated antiretroviral therapy (ART) (n = 96). Among them, 57.3% (n = 55) reported at least one HIVTI. Unmet surgical needs (aOR = 1.6), past-year marijuana use (aOR = 14.6), and no current hormone use (aOR = 24.9) were significantly (p < 0.05) associated with HIVTIs in multivariable analysis. Unmet need for gender affirmation may inhibit ART adherence, highlighting opportunities to mitigate care interruptions in alignment with community needs and goals.

Resumen

Las mujeres transgéneras negras y latinas (MTNL) son afectadas de manera desproporcionada por el VIH, pero están insuficientemente representadas en las investigaciones sobre el VIH y los servicios de salud. Entre marzo del 2016 y mayo del 2017, reclutamos MTNL (N = 201) en Baltimore, Maryland, y Washington, DC, a través de un muestreo de conveniencia para una encuesta que evaluó los determinantes de niveles múltiples del riesgo de VIH y del tratamiento del VIH. Las entrevistas concluyeron con una prueba oral rápida de VIH. Realizamos una regresión logística bivariada y multivariada para identificar los correlatos relacionados con la afirmación de género de las interrupciones del tratamiento del VIH (ITVIH) entre las MTNL que viven con el VIH que habían iniciado la terapia antirretroviral (TAR) (n = 96). Entre ellas, 57,3% (n = 55) reportaron al menos una ITVIH. Las necesidades quirúrgicas que no fueron satisfechas (aOR = 1.6), el uso de marihuana durante el año anterior (aOR = 14.6), y la falta del uso de hormonas para afirmación de género (aOR = 24.9) están significativamente asociadas (p < 0.05) con las ITVIH en el análisis multivariada. La necesidad insatisfecha de afirmación de género puede inhibir la adherencia al TAR, destacando oportunidades para mitigar las ITVIH en concordancia con las necesidades y objetivos de la comunidad transgénera.

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Acknowledgements

We are grateful to Jean-Michel Brevelle, Falina Laron, Deborah Dunn, Ruby Corado, Alexa Rodriguez, Paty Hernandez, and Wendy Aly Escobar for their support with piloting the survey, study recruitment, and data dissemination. We are also thankful for the generous collaborative partnerships offered by the leadership and staff of Casa Ruby, Whitman Walker Health, and the DC Center. We would like to thank the people living with HIV who have generously shared their time, experiences, and bodies for the purposes of this research. Funding support was provided by the Johns Hopkins University Center for AIDS Research (P30AI094189) and the District of Columbia Center for AIDS Research (AI117970), NIH funded programs, supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. This research was also supported in part by a National Institutes of Health/National Institute for Allergy and Infectious Diseases supplement to T. Poteat (P30AI094189‐01A1). Support for this research also comes from the ADELANTE grant (AI050409) from the Centers for AIDS Research program at the National Institutes of Health to T. Yamanis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

This publication resulted from research supported by the Johns Hopkins University Center for AIDS Research (P30AI094189) and the District of Columbia Center for AIDS Research (AI117970), NIH funded programs, supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. This research was also supported in part by a National Institutes of Health/National Institute for Allergy and Infectious Diseases supplement to T. Poteat (P30AI094189‐01A1). Support for this research also comes from the ADELANTE grant (AI050409) from the Centers for AIDS Research program at the National Institutes of Health to T. Yamanis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Joseph G. Rosen

  2. Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Mannat Malik, Erin E. Cooney, Andrea L. Wirtz & Tonia Poteat

  3. School of International Service, American University, Washington, DC, USA

    Thespina Yamanis & Maren Lujan

  4. Whitman Walker Health, Washington, DC, USA

    Christopher Cannon

  5. Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David Hardy

  6. Department of Social Medicine, University of North Carolina School of Medicine, 333 South Columbia Street, MacNider Hall, Room #348/CB #7240, Chapel Hill, NC, 27599-7240, USA

    Tonia Poteat

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  1. Joseph G. Rosen
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Contributions

TP, ALW, MM, EEC, and TY developed data collection instruments. MM, EEC, and ML led study recruitment and data collection. CC and DH supervised study recruitment in Washington, DC and supported local data dissemination. JGR, MM, and EEC performed data analysis. JGR led writing of the draft manuscript. All authors reviewed, revised, and approved the final version of the manuscript presented for publication.

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Correspondence to Tonia Poteat.

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Rosen, J.G., Malik, M., Cooney, E.E. et al. Antiretroviral Treatment Interruptions Among Black and Latina Transgender Women Living with HIV: Characterizing Co-occurring, Multilevel Factors Using the Gender Affirmation Framework. AIDS Behav 23, 2588–2599 (2019). https://doi.org/10.1007/s10461-019-02581-x

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