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Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study

Authors :
Mona Loutfy
Alexandra de Pokomandy
Nadia O Brien
Mostafa Shokoohi
Ashley Lacombe-Duncan
Carmen H. Logie
Yasmeen Persad
Greta R. Bauer
Peter A. Newman
Angela Kaida
Source :
Sexual Health. 16:367
Publication Year :
2019
Publisher :
CSIRO Publishing, 2019.

Abstract

Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.

Details

ISSN :
14485028
Volume :
16
Database :
OpenAIRE
Journal :
Sexual Health
Accession number :
edsair.doi.dedup.....561fd6064e049efa39dfef6239a6cd78