Department of Medicine, Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, United State of America.
Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, D.C., United States of America.
PLoS One. 2018 May 22;13(5):e0197730. doi: 10.1371/journal.pone.0197730. eCollection 2018.
Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system.
To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5.
Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p<0.001); both TW and CM reported high rates of condomless sex (58%, 64%, respectively); TW were more likely than CM to have more than one sexual partner (OR = 2.9, 95% CI: 1.6, 5.2; p<0.001) and have engaged in exchange sex (OR = 3.9, 95% CI: 2.3, 6.6; p<0.001). There were no significant differences between TW and CM in the percentage currently taking ART (52%, 49%, respectively), the mean percent adherence to ART (77% for both groups), and the proportion who achieved viral suppression (61%, 58%, respectively).
HIV-infected CJ-involved TW and CM had similar use of ART and viral suppression but TW were more likely than matched CM to engage in exchange sex, have multiple sexual partners, and use crack/cocaine. TW and CM had similarly high rates of condomless sex and use of other drugs. TW require tailored risk reduction interventions, however both CJ-involved TW and CM require focused attention to reduce HIV risk and improve HIV continuum of care outcomes.
与顺性别者相比，跨性别者受到高度侵害、边缘化，不成比例地被监禁，艾滋病毒感染率惊人地增加。很少有研究检查跨性别女性（TW）的艾滋病毒护理连续体结果，特别是与刑事司法（CJ）系统有关的 TW。
为了更好地了解与 CJ 系统有关的感染艾滋病毒的 TW 人群的艾滋病毒护理连续体结果和风险行为，我们分析了美国国家药物滥用研究所支持的寻求、测试、治疗、保留（STTR）数据协调倡议的数据。从三个美国 STTR 研究中汇集和分析了基线数据，以检查与 cisgender 男性（CM）相比，与 CJ 相关的感染艾滋病毒的 TW 中的 HIV 风险和护理连续体指标，CM 按年龄（5 年内）匹配，并以 1:5 的比例匹配。
研究包括 88 名 TW 和 440 名 CM。在匹配的参与者中，TW 报告使用冰毒和可卡因的比例高于 CM（分别为 40%和 16%，p<0.001）；TW 和 CM 均报告了很高的无保护性行为率（分别为 58%和 64%）；TW 比 CM 更有可能有多个性伴侣（OR = 2.9，95%CI：1.6，5.2；p<0.001）和从事性交易（OR = 3.9，95%CI：2.3，6.6；p<0.001）。TW 和 CM 目前接受抗逆转录病毒治疗（ART）的比例（分别为 52%和 49%）、接受 ART 的平均百分比（两组均为 77%）以及实现病毒抑制的比例（分别为 61%和 58%）均无显著差异。
感染艾滋病毒的与 CJ 相关的 TW 和 CM 同样使用抗逆转录病毒治疗和病毒抑制，但 TW 比匹配的 CM 更有可能从事性交易、有多个性伴侣和使用冰毒/可卡因。TW 和 CM 有类似的无保护性行为和使用其他药物的高比率。TW 需要量身定制的减少风险干预措施，但与 CJ 有关的 TW 和 CM 都需要集中注意力，以降低艾滋病毒风险并改善艾滋病毒护理连续体的结果。
