Lacombe-Duncan Ashley, Newman Peter A, Bauer Greta R, Logie Carmen H, Persad Yasmeen, Shokoohi Mostafa, O Brien Nadia, Kaida Angela, de Pokomandy Alexandra, Loutfy Mona
School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, Michigan 48109-1106, USA; and Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada; and Corresponding author. Email:
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
Sex Health. 2019 Aug;16(4):367-376. doi: 10.1071/SH19011.
Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH.
This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding.
Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5-67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3-29.2%). Factors significantly associated with not having begun one's medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care.
HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.
背景：在感染艾滋病毒的人群中，跨性别女性（跨女）的占比过高，但感染艾滋病毒的跨性别女性（HIV 跨女）获得艾滋病毒护理的机会较少。获得医疗过渡可能有助于 HIV 跨女获得艾滋病毒护理。本研究旨在描述 HIV 跨女在获得医疗过渡方面的障碍和促进因素。
这项收敛性平行混合方法研究利用了 48 名 HIV 跨女的横断面定量数据，采用描述性和双变量分析进行分析，以及来自 11 名参与者子样本的定性半结构化访谈数据，采用框架分析进行分析。主要结果是自我报告的过渡经历（已完成或正在进行医疗过渡与计划进行但尚未开始医疗过渡）。对定量和定性结果进行合并和分析，以了解其趋同、分歧和/或扩展情况。
略多于一半的参与者报告已完全完成医疗过渡或正在进行医疗过渡（52.1%（25/48）；95%置信区间（CI）37.5 - 67.6%），五分之一的参与者报告计划进行但尚未开始医疗过渡（18.8%（9/48）；95%CI 8.3 - 29.2%）。与尚未开始医疗过渡显著相关的因素包括住房不稳定、恐跨症、与艾滋病毒相关的耻辱感以及获得护理的障碍。定性研究结果揭示了受社区规范、通过和阶级特权、艾滋病毒及结构性障碍影响的不同过渡经历。混合方法研究结果表明，在跨性别和艾滋病毒医疗保健方面，HIV 跨女与艾滋病毒护理提供者之间存在积极关系。
与艾滋病毒相关的耻辱感和健康的社会决定因素限制了 HIV 跨女获得医疗过渡的机会。除了结构性障碍外，还必须在广泛的医疗保健环境中解决耻辱感问题，以增加 HIV 跨女获得性别确认的艾滋病毒护理和医疗过渡的机会。
