This Week in HIV Research: Transgender Women in the Spotlight

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In our latest brief tour of newly published HIV research highlights, we touch on a few topics -- and communities -- that tend not to garner a great deal of attention in the U.S. today. Specifically, this week we explore:

  • A survey showing we have largely failed to ensure that black transgender women are engaged in the HIV care continuum.
  • A signal that pre-exposure prophylaxis (PrEP) uptake could be high among trans women -- if they're properly informed about its existence.
  • A reminder that mother-to-child HIV transmission remains a reality in the U.S., albeit at record-low overall rates.
  • A meta-analysis that questions the need for supplemental measles vaccination in people living with HIV.

Let's take a moment to give each of these study findings its due. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.


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Undiagnosed HIV Seroconversions Still Common Among Black Trans Women

Many African-American transgender women living with HIV are unaware of their status, according to survey results reported in Journal of Acquired Immune Deficiency Syndrome.

Researchers analyzed data provided by 422 black trans women (BTW) who had been recruited at Black Pride events in six U.S. cities. Participants answered survey questions and agreed to on-site HIV testing. Forty-five percent of participants were found to be living with HIV; 51% of those women reported in their survey that they were not HIV positive. Only 25% of participants who tested HIV positive reported that they were virally suppressed. Homelessness, physical assault, intimate partner violence, and current hormone use were associated with a detectable viral load.

While 78% of participants reported having health insurance, only 44.3% said they could access health care. Lack of health care access and having been in jail during the previous two years were associated with undiagnosed HIV.

Once diagnosed, 96% were linked to care, and the same percentage were retained in care.

Data underscore the need for trauma-informed care that considers the multiple health challenges faced by BTW, study authors concluded. They called for targeted interventions to advance test-and-treat strategies in this population.


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Trans Women Usually Willing to Try PrEP -- Once They Know About It

Transgender women in Rio de Janeiro, Brazil, are generally willing to use PrEP, but few know about this prevention method, according to a study published in Journal of Acquired Immune Deficiency Syndrome.

Only 38% of the study's 345 participants had heard of PrEP. Once it was explained, 76% of self-reported HIV-negative women were willing to try it. However, concerns about side effects (reported by 76% of those willing to try PrEP), long-term effects (74%), and interaction with hormones (76%) were common. Study authors recommended PrEP awareness campaigns targeted at trans women that also address this population’s concerns about biomedical HIV prevention.

Ensuring that PrEP information is provided by other trans women may be effective in helping achieve this goal, according to an analysis published by Aidsmap. The article highlighted focus groups conducted in Brazil in which trans women expressed greater trust in information from their peers and shared their experiences of transphobia in public health care settings. The results from both studies suggest the need for more PrEP education and access for trans communities, the article concluded.


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Elimination of Perinatal HIV Transmission Within Reach in U.S.

While the U.S. has not yet eliminated perinatal HIV transmissions, the number of infants born with the virus continues to fall, researchers noted in AIDS.

In 1993, 1,630 babies acquired HIV before, during, or soon after birth. In 2015, that figure had dropped to 53, an unprecedentedly low number. This success can be attributed to several interventions: routine opt-out HIV testing and, if necessary, antiretroviral treatment, during pregnancy; cesarean section in women with high viral loads; and no breastfeeding by women living with HIV.

Yet, disparities remain, with African-American women and those in the Southern U.S. most vulnerable to mother-to-child transmission (MTCT) of HIV. Furthermore, ending MTCT is not a one-time goal, but requires ongoing investment, researchers warned. They called for perinatal HIV surveillance systems, research into optimized treatment strategies and a cure for HIV, and concerted efforts to prevent seroconversion in pregnant women, among other strategies, to achieve zero perinatal HIV transmissions in the U.S.


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Study Questions Value of Extra Measles Vaccination for Adults With HIV

Currently available evidence does not support the administration of an additional dose of measles vaccine for all adults and adolescents living with HIV, a systematic research review published in Clinical Infectious Diseases found.

The investigators compared the results of 30 studies, 10 of which included HIV-negative controls. They found no significant difference in measles seroprevalence based on HIV status. While the level of measles antibodies dropped faster after vaccination in people living with HIV compared to controls, it stayed within the protective range in both groups -- and the authors noted that immunity to measles may persist even if antibodies to the infectious disease can no longer be detected. The authors reported that they were unable to find any studies exploring the effectiveness of measles vaccination for adults or adolescents living with HIV, though the vaccine did appear to be safe in cases where a person was not severely immunocompromised. Further conclusions were not possible because study designs were too heterogeneous and information on participants was inconsistent, the authors wrote.

This review supports the World Health Organization’s recommendations regarding measles vaccination among people with HIV: vaccinate children, as well as adults who may be susceptible to measles and are not severely immunocompromised.