Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY; and.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
J Acquir Immune Defic Syndr. 2022 Nov 1;91(3):255-260. doi: 10.1097/QAI.0000000000003056.
Transgender women (transwomen) are frequently conflated with cisgender sexual minority men (cis-SMM) in HIV research. We examined the impact of socioeconomic and health conditions, and gender-affirming hormones in comparing HIV-related outcomes between cis-SMM and transwomen.
Large tertiary care health system in the Bronx, NY.
Retrospective cohort study of people with HIV receiving care in 2008-2017. We compared retention in care, antiretroviral therapy (ART) prescription, and viral suppression between cis-SMM and transwomen, using modified Poisson regression, adjusting for demographic and clinical factors. Transwomen were further stratified by receipt of estrogen prescription.
We included 166 transwomen (1.4%), 1936 cis-SMM (17%), 4715 other cisgender men (41%), and 4745 cisgender women (41%). Transwomen were more likely to have public insurance (78% vs 65%) and mental health (49% vs 39%) or substance use (43% vs 33%) diagnoses than cis-SMM. Compared with cis-SMM, transwomen prescribed estrogen (67% of transwomen) were more likely to be retained [adjusted risk ratio (aRR) 1.15, 95% confidence interval (CI) 1.08 to 1.23), prescribed ART (aRR 1.06, CI 1.01 to 1.11), and virally suppressed (aRR 1.08, CI 1.01 to 1.16). Transwomen not prescribed estrogen were less likely to be retained (aRR 0.92, CI 0.83 to 1.02), prescribed ART (aRR 0.90, CI 0.82 to 0.98), or virally suppressed (aRR 0.85, CI 0.76 to 0.95).
In the context of HIV, socioeconomic factors, comorbidities, and gender-affirming care distinguish transwomen from cis-SMM. Compared with cis-SMM, transwomen who were prescribed estrogen had better HIV care continuum outcomes; transwomen not prescribed estrogen had worse outcomes. These differences should be accounted for in HIV-related research.
在 HIV 研究中，跨性别女性（transwomen）经常与顺性别性少数男性（cis-SMM）混淆。我们研究了社会经济和健康状况以及性别肯定激素对 cis-SMM 和 transwomen 之间 HIV 相关结局的影响。
纽约布朗克斯的大型三级保健系统。
这是一项回顾性队列研究，纳入了 2008 年至 2017 年期间接受治疗的 HIV 感染者。我们使用修正泊松回归比较了 cis-SMM 和 transwomen 之间的保留在治疗中、接受抗逆转录病毒治疗（ART）处方和病毒抑制情况，同时调整了人口统计学和临床因素。根据接受雌激素处方的情况，对 transwomen 进一步分层。
我们纳入了 166 名 transwomen（1.4%）、1936 名 cis-SMM（17%）、4715 名其他顺性别男性（41%）和 4745 名顺性别女性（41%）。与 cis-SMM 相比，transwomen 更有可能拥有公共保险（78% vs 65%）和心理健康（49% vs 39%）或物质使用障碍（43% vs 33%）诊断。与 cis-SMM 相比，接受雌激素治疗的 transwomen（67%的 transwomen）更有可能保留在治疗中[调整后的风险比（aRR）1.15，95%置信区间（CI）1.08 至 1.23]、接受 ART 处方（aRR 1.06，CI 1.01 至 1.11）和病毒抑制（aRR 1.08，CI 1.01 至 1.16）。未接受雌激素治疗的 transwomen 保留在治疗中的可能性较低（aRR 0.92，CI 0.83 至 1.02）、接受 ART 处方（aRR 0.90，CI 0.82 至 0.98）或病毒抑制（aRR 0.85，CI 0.76 至 0.95）。
在 HIV 背景下，社会经济因素、合并症和性别肯定护理将 transwomen 与 cis-SMM 区分开来。与 cis-SMM 相比，接受雌激素治疗的 transwomen 具有更好的 HIV 护理连续结局；未接受雌激素治疗的 transwomen 结局较差。在与 HIV 相关的研究中，应考虑这些差异。
