Treatment Engagement and Adherence among HIV+ Transwomen

Investigator: Jae Sevelius, PhD
Sponsor: California HIV/AIDS Research Program

Location(s): United States


In recent years, evidence of the disproportionate rates of HIV infection among transgender women in California has been rapidly increasing. The importance of early initiation of ART and optimal adherence to promote health and reduce transmission is widely recognized. However, there has been little to no systematic investigation into HIV treatment and adherence issues for transgender women.  Transgender women living with HIV are less likely to be receiving antiretroviral therapy (ART) than other groups, less likely to report optimal adherence rates, and report less confidence in their abilities to integrate treatment regimens into their daily lives.  Transgender women also report significantly less positive interactions with their health care providers.  Adherence to ART is difficult due to factors such as the complexity of the regimens, side effects, HIV-related stigma, and competing priorities and demands.  Transgender women living with HIV face culturally unique challenges in adhering to HIV care and treatment regimens, such as limited access to and avoidance of healthcare due to stigma and past negative experiences, prioritization of gender-related healthcare, and concerns about adverse interactions between ART and hormone therapy.

This project aims to explore the unique challenges to antiretroviral therapy (ART) treatment engagement and adherence faced by transgender women living with HIV. We will explore HIV+ transgender women’s experiences, perspectives, and life contexts of ART treatment and adherence through in-depth individual interviews and focus groups through the lens of an innovative Health Care Empowerment model.  We will interview transgender women living with HIV in the Bay Area regarding their experiences of treatment regimens, experiences of and concerns about adverse side effects, access to and relationships with providers, issues and concerns around treatment, adherence, and retention in care. We will also interview providers who work with HIV+ transgender women to include their perspectives on barriers to treatment initiation and adherence among their clients.

Achieving high levels of adherence to ART is critical to allow people living with HIV to live longer, healthier lives, to promote viral suppression to reduce the chances of HIV transmission to sex partners, and to minimize the emergence of drug-resistant virus. This project will initiate a line of research investigating ART adherence issues among transgender women and the development of approaches to improving adherence to ART among transgender women with a particular focus on the socio-political environment in California.  With the data from this study, we will leverage NIH funding to pilot an intervention to increase ART engagement and adherence among HIV+ transgender women. The current project is a critical step in efforts to understand and mitigate the forces that result in disproportionately poor health outcomes among this understudied and underserved group.