Burnett Janet, Olansky Evelyn, Baugher Amy R, Lee Kathryn, Callens Steven, Wejnert Cyprian
Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA; and.
Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium .
J Acquir Immune Defic Syndr. 2025 Feb 1;98(2):123-132. doi: 10.1097/QAI.0000000000003543.
Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women than among cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women with a general sample of persons who inject drugs.
Participants from the National HIV Behavioral Surveillance were recruited through respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics.
Among 1561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (adjusted prevalence ratio = 1.5, 95% confidence interval: 1.2 to 1.8) than among those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (adjusted prevalence ratio = 0.8, 95% confidence interval: 0.7 to 1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%).
Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to nonjudgmental and culturally competent harm reduction services.
跨性别女性在健康差异方面仍面临重大负担，艾滋病毒感染是一个关键的公共卫生问题。跨性别女性的药物使用情况比顺性别女性更为普遍。然而，在美国，对于注射毒品的跨性别女性及其感染艾滋病毒的风险了解甚少。本研究的目的是探讨注射毒品的跨性别女性中的艾滋病毒流行情况、与注射相关的行为以及艾滋病毒预防和护理结果，并将跨性别女性与注射毒品者的一般样本进行比较。
通过应答驱动抽样从国家艾滋病毒行为监测中招募参与者，于2019年至2020年进行访谈并检测艾滋病毒感染情况。使用对数链接泊松回归模型来检验注射毒品使用与选定特征之间的关联。
在1561名跨性别女性中，7%在过去12个月内注射过毒品。注射毒品的跨性别女性中的艾滋病毒流行率高于未注射者（调整后的流行率比值 = 1.5，95%置信区间：1.2至1.8）。多种社会心理状况与注射毒品使用有关。在感染艾滋病毒的跨性别女性中，注射毒品者接受抗逆转录病毒治疗的可能性低于未注射者（调整后的流行率比值 = 0.8，95%置信区间：0.7至1.0）。甲基苯丙胺是最常注射的毒品（67%）；大多数人使用过注射器服务项目（66%）。
注射毒品的跨性别女性在健康结果方面面临重大挑战，包括艾滋病毒高流行率以及暴露于无家可归、监禁和性交易等社会心理状况，这些可能会加剧与注射毒品使用相关的风险。这一人群可能会受益于更多地获得无歧视且具有文化能力的减少伤害服务。
