Lodge William, Chaudary Jatin, Rawat Shruta, Agénor Madina, Dange Alpana, Anand Vivek R, Operario Don, Mimiaga Matthew J, Biello Katie B
Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA.
Cornell Center for Health Policy, Cornell University, Ithaca, NY, USA.
Glob Public Health. 2025 Dec;20(1):2473446. doi: 10.1080/17441692.2025.2473446. Epub 2025 Mar 6.
Transgender women (TGW) in India face one of the highest HIV prevalence rates among key populations in India, yet data on their engagement in the HIV care cascade is limited. This study investigates barriers and supportive factors for adhering to antiretroviral therapy (ART), which is vital for achieving viral suppression, reducing transmission risk to nearly zero (i.e. undetectable = utransmittable; U = U), and enhancing the quality of life for TGW living with HIV. Between July and September 2023, trained community recruiters recruited 30 TGW living with HIV in Mumbai and New Delhi, India. Using intersectionality and syndemic theory as guiding frameworks, we purposively sampled and conducted semi-structured qualitative interviews. The interviews revealed four main themes - two barriers and two supportive factors influencing ART adherence: the impact of poverty on syndemic factors, intersectional stigma and discrimination, empowerment to overcome barriers, and the influence of inclusive government programmes and policies in improving TGW's access to ART. Despite the availability of free ART immediately after diagnosis under India's 'test and treat' policy, economic instability and intersecting stigma hinder adherence. Our findings reveal that holistic interventions focusing on economic support, stigma reduction, and personal and collective empowerment might improve ART adherence among TGW in India.
印度的跨性别女性在印度重点人群中面临着最高的艾滋病毒感染率之一，但关于她们参与艾滋病毒治疗流程的数据却很有限。本研究调查了坚持抗逆转录病毒疗法（ART）的障碍和支持因素，这对于实现病毒抑制、将传播风险降至几乎为零（即检测不到=无传染性；U=U）以及提高感染艾滋病毒的跨性别女性的生活质量至关重要。2023年7月至9月期间，经过培训的社区招募人员在印度孟买和新德里招募了30名感染艾滋病毒的跨性别女性。以交叉性和综合征理论为指导框架，我们进行了有目的抽样并开展了半结构化定性访谈。访谈揭示了四个主要主题——影响抗逆转录病毒疗法依从性的两个障碍和两个支持因素：贫困对综合征因素的影响、交叉污名和歧视、克服障碍的赋权，以及包容性政府计划和政策对改善跨性别女性获得抗逆转录病毒疗法机会的影响。尽管根据印度的“检测即治疗”政策，确诊后可立即获得免费抗逆转录病毒疗法，但经济不稳定和交叉污名阻碍了依从性。我们的研究结果表明，侧重于经济支持、减少污名以及个人和集体赋权的整体干预措施可能会提高印度跨性别女性对抗逆转录病毒疗法的依从性。
