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Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities

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A Correction to this article was published on 20 November 2023

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Abstract

Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships—termed economic marginality—are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.

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Acknowledgements

We would like to thank all the participants who made this work possible. We would also like to thank Jordan Dworkin, Hanga Galfalvy, Dan Alschuler, and Curtis Dolezal for their help with statistical analyses. This work is supported in part by the National Institute for Mental Health (K01MH128117, PI: Paine), the National Heart, Lung, and Blood Institute (R01HL151559; PIs: Bocking & Edmondson), and the National Institute of Child Health & Human Development (R01HD07960, PI: Bockting).

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Authors and Affiliations

  1. Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA

    Emily Allen Paine & Walter O. Bockting

  2. New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA

    Emily Allen Paine, Dennis Rivera-Cash, Jasmine M. Lopez & Walter O. Bockting

  3. Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA

    Allen J. LeBlanc

  4. Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA

    Anneliese A. Singh

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  1. Emily Allen Paine
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Correspondence to Emily Allen Paine.

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This study was approved by the New York State Psychiatric Institute / Columbia Psychiatry Institutional Review Board.

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The original online version of this article was revised: “In the original version of this article, the rows of Table 1 describing sample Personal Income were misaligned and therefore incorrect. Also, the P-values corresponding to the “Times Moved in Last Year” and “HIV testing frequency” were misaligned in Table 1. Finally, Observations and R squared values were not aligned under the correct columns in Tables 4 – 9”

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Paine, E.A., Rivera-Cash, D., Lopez, J.M. et al. Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities. AIDS Behav 28, 1197–1209 (2024). https://doi.org/10.1007/s10461-023-04143-8

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