Transgender women living with HIV are less likely to be retained in care than cisgender women and men, but once in care, they have similar rates of viral suppression, a U.S. study published in Clinical Infectious Diseases showed.
The authors included data on 396 trans women, 14,094 cis women, and 101,667 cis men who are part of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Data spanned a wide time period, ranging from 2001 to 2015. Overall, the prevalence of retention in care was found to be lower for trans women than cisgender people -- and it did not improve during the course of the study. Counter to the researchers' initial hypothesis, however, viral suppression was just as likely among trans women as it was among cisgender people after adjusting for age, race, HIV risk group, and cohort.
Fear of revealing their gender identity or experience with poor treatment by medical providers may keep trans folk from accessing HIV treatment, explaining the retention difference, the authors surmised. They also noted that other research has shown improvement in viral suppression rates when the same clinician provides both gender-affirming and HIV care; the NA-ACCORD sites provide both types of care, which may explain why adjusted analyses showed no difference in viral suppression, despite lower retention in care, study authors noted.
Given the diverse demographics found within the transgender cohort, the authors recommended that efforts to engage young people of color in HIV care include transgender concerns, such as potential interactions between HIV medications and hormone therapy, to help engage this population in HIV care.