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Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

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Abstract

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.

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Acknowledgements

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.

Funding

This work was supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the National Institute of Child Health and Human Development (B. Kapogiannis, S. Lee), with supplemental funding from the National Institutes on Drug Abuse and Mental Health. Dr. Gary Harper was the Protocol Chair (PI) of ATN 130: Assessing the Engagement of Gender Minority Youth Across the HIV Continuum of Care. Protocol Vice-Chairs (Co-Is) were Dr. Sari Reisner, Miguel Martinez, and Liza Salomon. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the U.S. Government.

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Authors and Affiliations

  1. Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Sari L. Reisner

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sari L. Reisner

  3. The Fenway Institute, Fenway Health, Boston, MA, USA

    Sari L. Reisner, Jaclyn M. White Hughto & Liz Salomon

  4. Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Laura Jadwin-Cakmak & Gary W. Harper

  5. Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA

    Laura Jadwin-Cakmak & Gary W. Harper

  6. Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Jaclyn M. White Hughto

  7. Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Miguel Martinez

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  1. Sari L. Reisner
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  4. Miguel Martinez
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  5. Liz Salomon
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  6. Gary W. Harper
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Corresponding authors

Correspondence to Sari L. Reisner or Gary W. Harper.

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All study activities were approved at the Institutional Review Boards at the 14 Adolescent Medicine Trials Unit (AMTU) sites, as well as investigators’ institutions.

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The authors have no relevant conflicts of interest to disclose.

Ethical Approval

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.

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Informed consent was obtained from all individuals participants included in the study.

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Reisner, S.L., Jadwin-Cakmak, L., White Hughto, J.M. et al. Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.. AIDS Behav 21, 3312–3327 (2017). https://doi.org/10.1007/s10461-017-1938-8

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