Kalichman Seth C, Hernandez Dominica, Finneran Stephanie, Price Devon, Driver Redd
Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269.
Sex Health. 2017 Oct;14(5):469-476. doi: 10.1071/SH17015.
Background Transgender women living with HIV infection experience poorer health outcomes across the HIV continuum of care. While disparities are well established, their underlying mechanisms are not well understood. This study examined the HIV continuum of care (also known as the HIV treatment cascade), including linkage and engagement in care and health status among transgender women and cisgender women and cisgender men living with HIV.
Case-control matching was applied to a cohort of 1101 people living with HIV; 70 transgender women living with HIV were matched on years since testing HIV positive with cisgender women and cisgender men. Participants provided measures indicative of the HIV treatment cascade that included linkage and engagement in care, receiving and adhering to antiretroviral therapy (ART), and HIV viral suppression. Common correlates of HIV-related health status: depression symptoms, HIV-related stress, alcohol and drug use, healthcare conspiracy beliefs, medical mistrust, emotional social support and tangible social support, were also assessed.
Transgender women were significantly less likely to receive ART, were less adherent to ART and had poorer HIV viral suppression than cisgender persons. Multivariable models demonstrated that health disparities were predicted by transgender women having poorer tangible social support over and above the other correlates of health outcomes.
Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.
背景 感染艾滋病毒的跨性别女性在艾滋病毒连续护理过程中健康状况较差。虽然差异已得到充分证实，但其潜在机制尚不清楚。本研究调查了艾滋病毒连续护理（也称为艾滋病毒治疗级联），包括感染艾滋病毒的跨性别女性、顺性别女性和顺性别男性在护理方面的联系与参与情况以及健康状况。
对1101名艾滋病毒感染者进行病例对照匹配；70名感染艾滋病毒的跨性别女性与艾滋病毒检测呈阳性时间相同的顺性别女性和顺性别男性进行匹配。参与者提供了表明艾滋病毒治疗级联的指标，包括护理方面的联系与参与情况、接受和坚持抗逆转录病毒疗法（ART）以及艾滋病毒病毒抑制情况。还评估了与艾滋病毒相关健康状况的常见相关因素：抑郁症状、艾滋病毒相关压力、酒精和药物使用、医疗保健阴谋论信念、医疗不信任、情感社会支持和实际社会支持。
与顺性别者相比，跨性别女性接受抗逆转录病毒疗法的可能性显著降低，对抗逆转录病毒疗法的依从性较低，艾滋病毒病毒抑制情况较差。多变量模型表明，除了健康结果的其他相关因素外，跨性别女性实际社会支持较差预示着健康差异。
实际支持可通过建立和加强支持网络及辅助专业服务等干预措施来改善。在减少跨性别女性艾滋病毒健康差异的努力中，社会支持性干预措施应被视为至关重要。
