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Patterns of Exposure to Socio-structural Stressors and HIV Care Engagement Among Transgender Women of Color

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Abstract

Transgender women are disproportionately affected by HIV and experiences of social adversity that may interfere with engagement in care and viral suppression. We used latent class analysis to examine patterns of social adversity and their impact on HIV care continuum outcomes in an urban sample of transgender women of color. Participants (n = 224) were median age 29 and 86% non-Hispanic Black. Lack of resources, unemployment, and housing instability were reported by over 50%, and 41% reported history of incarceration. Latent class analysis identified 2 distinct classes representing higher and lower levels of social adversity. In latent class regression, membership in the higher social adversity class was associated with statistically significantly lower odds of viral suppression and HIV care engagement in univariate analysis; when adjusted for age, race, and recruitment site the association remained statistically significant for viral suppression (aOR 0.38, 95% CI 0.18–0.79; chi-square = 6.681, d.f. = 1, p = 0.010), though not for HIV care engagement. Our findings highlight the impact of socio-structural barriers on engagement in the HIV care continuum among transgender women.

Resumen

Las mujeres transgénero son desproporcionadamente afectadas por el VIH y las experiencias de adversidad social que pueden interferir con la participación en la atención medica y la supresión viral. Utilizamos un análisis de clase latente para examinar los patrones de adversidad social y su impacto en los resultados continuos de la atención medica del VIH en una muestra urbana de mujeres transgénero de color. Los participantes (n = 224) tenían una mediana de edad de 29 años y 86% negros no hispanos. La falta de recursos, el desempleo y la inestabilidad de la vivienda fueron reportados en más del 50%, y el 41% reportó antecedentes de encarcelamiento. El análisis de clase latente identificó 2 clases distintas que representan niveles más altos y más bajos de adversidad social. En la regresión de clase latente, la pertenencia a la clase de mayor adversidad social se asoció con probabilidades estadísticamente significante más bajas de supresión viral y participación en la atención medica del VIH en el análisis univariante; cuando se ajustó por edad, raza y sitio de reclutamiento, la asociación siguió siendo estadísticamente significativa para la supresión viral (aOR 0.38, IC 95% 0.18–0.79; chi-cuadrado = 6.681, df = 1, p = 0.010), aunque no para la participación en la atención medica del VIH. Nuestros hallazgos destacan el impacto de las barreras socioestructurales en la participación en el continuo de atención medica del VIH entre las mujeres transgénero.

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Acknowledgements

We thank members of the staff at Chicago House and Howard Brown Health, including Jahara Carey, Gnathan Carpenter, Aleksander Casas, Savannah J. Frazier-Willis, Adrianna Maldonado, Symone McDaniel, Blue Roth, Sikora Sikorski, Lia Stokes, and others for their contribution to sample accrual and data collection and their dedication to improving the quality of care provided to the transgender women of color involved in the study. Without their efforts and community relationships, this study would not have been possible. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Grant Numbers H97HA24965 and H97HA24969 awarded to Chicago House and Social Service Agency and Howard Brown Health in the amount of $300,000 to each site. 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.

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Authors and Affiliations

  1. Section of Infectious Diseases and Global Health & The Chicago Center for HIV Elimination, The University of Chicago Medicine, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA

    Anna L. Hotton

  2. Chicago House and Social Service Agency, Chicago, IL, USA

    Judy Perloff, Josie Paul & Channyn Parker

  3. Howard Brown Health, Chicago, IL, USA

    Kelly Ducheny & Trisha Holloway

  4. The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Amy K. Johnson, Robert Garofalo & Lisa M. Kuhns

  5. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Amy K. Johnson, Robert Garofalo & Lisa M. Kuhns

  6. Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL, USA

    James Swartz

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  1. Anna L. Hotton
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Correspondence to Anna L. Hotton.

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Hotton, A.L., Perloff, J., Paul, J. et al. Patterns of Exposure to Socio-structural Stressors and HIV Care Engagement Among Transgender Women of Color. AIDS Behav 24, 3155–3163 (2020). https://doi.org/10.1007/s10461-020-02874-6

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