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Health behaviors and outcomes in a U.S. cohort of transgender women in HIV care
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More Depression, Worse Quality of Life in Transgender Women vs Men With HIV
9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris
Mark Mascolini
Transgender women in care for HIV reported anxiety and depression more often than men with HIV in a 7-region US study [1]. Transgender women also reported a lower quality of life.
In the United States more than one quarter of transgender women test positive for HIV, a rate 34-fold higher than in the general US population. More than half of African-American transgender women have HIV infection. Because few studies have assessed health behaviors and outcomes in HIV-positive transgender women, researchers working with the US CNICS cohort conducted this study.
The analysis compared cross-sectional data on transgender women and cis-gender men in care for HIV and enrolled in one of 7 US CNICS centers sometime in 2000-2016. The investigators identified transgender women with an algorithm that combined clinical data and identity-based measures. Study measures included a visual analog scale of antiretroviral adherence (VAS), depression (PHQ-9), anxiety (PHQ-5), sexual risk behavior, substance/alcohol/tobacco use (ASSIST, AUDIT-C), and quality of life (EQ-5D). The researchers also recorded clinical data such as viral load and CD4 count. They used log-binomial regression models to compare each outcome in transgender women and men.
The study included 118 transgender women and 12,152 cis-gender men. Among transgender women, 41% were Hispanic, 29% African American, 23% white, and 7% another or unknown race/ethnicity. Respective proportions of men were 14%, 31%, 50%, and 5%. Transgender women did not differ significantly from cis-gender men in HIV suppression, CD4 count, antiretroviral adherence, prior or current substance use, binge drinking, or tobacco use.
Compared with men, transgender women proved significantly more likely to meet clinical thresholds for moderate to severe depression (29.8% versus 22.2%, P = 0.01), anxiety (43.4% versus 25.8%, P = 0.01), and worse quality of life (62.4% versus 46.7%, P = 0.01). A slightly lower proportion of transgender women than men reported hazardous drinking, but the difference reached statistical significance (21.3% versus 26.7%, P = 0.04). A lower proportion of transgender women reported condom-free sex, and this difference fell just short of statistical significance (42.4% versus 53.1%, P = 0.07).
The CNICS investigators encouraged improved mental health screening and enhanced support for transgender women with HIV.
Reference
1. Reisner S, Matsuzaki M, Nance R, et al. Health behaviors and outcomes in a U.S. cohort of transgender women in HIV care. 9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris. Abstract TUPEC0795.
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