Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, US.
AIDS Behav. 2023 Aug;27(8):2774-2784. doi: 10.1007/s10461-023-04001-7. Epub 2023 Feb 1.
Trans women experience multiple forms of intersecting stigma due to trans identity, HIV, and sex work, which can negatively affect their health. There is limited understanding of the relationships between stigma and HIV care and treatment outcomes. We assessed associations between multiple forms and types of stigma and HIV treatment outcomes among trans women who conduct sex work in Santo Domingo, Dominican Republic using cross-sectional survey data. Most participants had received HIV care (91%) and were currently taking anti-retroviral therapy (ART) (84%). Only 64% were virally suppressed. Nearly one-third (32%) had interrupted ART at some point; those who had never interrupted ART were more likely to be suppressed. Drug use was associated with ART interruption. Higher enacted HIV stigma was associated with current ART use. Higher enacted HIV stigma and higher anticipated sex work stigma were associated with ART adherence. Higher trans stigma was associated with being virally suppressed. Findings highlight the importance of addressing multiple forms of stigma at the individual and clinic levels to improve and sustain viral suppression. Future research is needed to assess if unexpected associations between stigma and HIV outcomes reflect processes of resilience. Future research is also needed to assess the pathways between drug use, ART interruption, and viral suppression among trans women.
跨性别女性由于跨性别身份、HIV 和性工作而经历多种形式的交叉污名，这可能对她们的健康产生负面影响。人们对污名与 HIV 护理和治疗结果之间的关系了解有限。我们使用横断面调查数据评估了多米尼加共和国圣多明各从事性工作的跨性别女性中多种形式和类型的污名与 HIV 治疗结果之间的关系。大多数参与者接受了 HIV 护理（91%）并正在接受抗逆转录病毒治疗（ART）（84%）。只有 64%的人病毒得到抑制。近三分之一（32%）的人在某个时候中断了 ART；从未中断过 ART 的人更有可能被抑制。药物使用与 ART 中断有关。更高的艾滋病污名与当前的 ART 使用有关。更高的艾滋病污名和更高的预期性工作污名与 ART 依从性有关。更高的跨性别污名与病毒抑制有关。研究结果强调了在个人和诊所层面上解决多种形式的污名的重要性，以改善和维持病毒抑制。需要进一步研究来评估污名与 HIV 结果之间的意外关联是否反映了恢复力的过程。还需要进一步研究来评估跨性别女性中药物使用、ART 中断和病毒抑制之间的途径。
