Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA.
Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
BMC Womens Health. 2024 Jan 22;24(1):56. doi: 10.1186/s12905-024-02885-8.
Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades.
Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher's exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades.
Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049).
We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women.
NCT, NCT 21-34,978. Registered January 19, 2022.
物质使用和精神困扰是跨性别女性参与 HIV 护理的已知障碍。关于跨性别女性获得和利用心理健康和物质使用护理的情况以及未满足的行为健康需求与 HIV 病毒抑制之间的关系，我们知之甚少。我们研究了 HIV 病毒载量与接受 HIV 治疗的跨性别女性之间的精神健康和物质使用之间的关系。我们还通过比较参与护理级联来检查精神健康和物质使用服务需求与 HIV 护理参与和检测到病毒载量之间的关系。
数据来自 2022 年对旧金山 HIV 阳性跨性别女性（n=42）进行的一项干预措施的基线评估。卡方检验或 Fisher 精确检验用于确定 HIV 病毒载量、精神健康和物质使用之间的关联。我们还检查了与 HIV、心理健康和物质使用护理级联的每个步骤相关的特征。
大多数参与者是跨性别女性（85.7%），年龄在 40 岁或以上（80.9%），收入较低（88.1%），近一半人住房不稳定（47.6%）。在筛查出患有抑郁症、焦虑症和/或心理困扰的 32 名参与者中，56.3%在过去 12 个月内被转介接受心理健康服务。在被转介的人中，44.4%接受了心理健康服务。在筛查出患有物质使用障碍的 26 名参与者中，34.6%在过去 12 个月内被转介接受物质使用服务。在被转介的人中，33.3%在过去 3 个月内接受了物质使用服务。拉丁裔跨性别女性的精神健康需求转介率较低（50%），只有 16.7%的筛查出患有物质使用障碍的非裔美国/黑人跨性别女性被转介接受服务，而其他种族/族裔的跨性别女性的转介和服务利用率较高。在 HIV 病毒载量和筛查出患有精神健康障碍之间未发现显著结果。甲基苯丙胺的使用与检测到 HIV 病毒载量之间存在统计学关联（p=0.049）。
我们发现了未满足的精神健康和物质使用服务需求，并注意到在 HIV 护理参与度高的情况下，跨性别女性存在种族/族裔差异。我们还发现，甲基苯丙胺的使用是 HIV 阳性的跨性别女性无法检测到病毒载量的障碍。为了最终结束 HIV 流行，在 HIV 感染者的 HIV 护理服务中需要整合行为健康筛查、联系和支持，尤其是在受 HIV 影响最大的人群中。
NCT，NCT 21-34，978。2022 年 1 月 19 日注册。
