School of Social Work, University of Michigan, Ann Arbor, MI, USA.
Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
Health Soc Care Community. 2021 Sep;29(5):e33-e46. doi: 10.1111/hsc.13234. Epub 2020 Nov 25.
Transgender (trans) women experience barriers to access to HIV care, which result in their lower engagement in HIV prevention, treatment and support relative to cisgender people living with HIV. Studies of trans women's barriers to HIV care have predominantly focused on perspectives of trans women, while barriers are most often described at provider, organisation and/or systems levels. Comparing perspectives of trans women and service providers may promote a shared vision for achieving health equity. Thus, this qualitative study utilised focus groups and semi-structured interviews conducted 2018-2019 to understand barriers and facilitators to HIV care from the perspectives of trans women (n = 26) and service providers (n = 10). Barriers endorsed by both groups included: (a) anticipated and enacted stigma and discrimination in the provision of direct care, (b) lack of provider knowledge of HIV care needs for trans women, (c) absence of trans-specific services/organisations and (d) cisnormativity in sexual healthcare. Facilitators included: (a) provision of trans-positive trauma-informed care, (b) autonomy and choice for trans women in selecting sexual health services and (c) models for trans-affirming systems change. Each theme had significant overlap, yet nuanced perspective, between trans women and service providers. Specific recommendations to improve HIV care access for trans women are discussed. These recommendations can be used by administrators and service providers alike to work collaboratively with trans women to reduce barriers and facilitators to HIV care and ultimately to achieve health equity for trans women.
跨性别（trans）女性在获得艾滋病护理方面面临障碍，这导致她们在艾滋病预防、治疗和支持方面的参与度相对低于艾滋病毒感染者中的顺性别者。关于跨性别女性获得艾滋病护理障碍的研究主要集中在跨性别女性的观点上，而障碍通常更多地描述为提供者、组织和/或系统层面的障碍。比较跨性别女性和服务提供者的观点可以促进实现健康公平的共同愿景。因此，这项定性研究利用 2018-2019 年进行的焦点小组和半结构化访谈，从跨性别女性（n=26）和服务提供者（n=10）的角度了解艾滋病护理的障碍和促进因素。两组都认可的障碍包括：（a）在提供直接护理时预期和实施的污名化和歧视，（b）提供者对跨性别女性艾滋病护理需求的了解不足，（c）缺乏针对跨性别者的服务/组织，以及（d）性保健方面的顺性别规范。促进因素包括：（a）提供对跨性别者积极的创伤知情护理，（b）跨性别女性在选择性健康服务方面的自主权和选择权，以及（c）跨性别肯定系统变革的模式。每个主题都在跨性别女性和服务提供者之间存在显著的重叠，但观点也有所细微差别。讨论了具体的建议，以改善跨性别女性获得艾滋病护理的机会。这些建议可供管理员和服务提供者共同使用，以便与跨性别女性合作，减少艾滋病护理的障碍和促进因素，最终实现跨性别女性的健康公平。
