Sunday, December 3, 2023
| Characteristic | No. (%) | |||||||
|---|---|---|---|---|---|---|---|---|
| Transgender women | Severe food insecurity§ | Nights homeless† | Has usual source of care¶ | Comfort with a health care provider when discussing gender-related issues | ||||
| 365 | 30–364 | <30 | None | |||||
| Age group, yrs | ||||||||
| 18–29 | 496 (30.9) | 244 (49.2) | 49 (9.9) | 135 (27.2) | 57 (11.7) | 247 (49.8) | 374 (75.4) | 357 (72.0) |
| 30–39 | 461 (28.7) | 186 (40.4) | 48 (10.4) | 105 (22.8) | 44 (9.5) | 258 (56.0) | 372 (80.7) | 344 (74.6) |
| 40–49 | 307 (19.1) | 113 (36.8) | 23 (7.5) | 57 (18.8) | 23 (7.5) | 192 (62.5) | 270 (88.0) | 254 (82.7) |
| ≥50 | 343 (21.3) | 94 (27.4) | 32 (9.3) | 41 (12.0) | 15 (4.4) | 238 (69.4) | 308 (89.8) | 295 (86.0) |
| Race and ethnicity** | ||||||||
| Black, non-Hispanic | 569 (35.4) | 221 (38.8) | 63 (11.1) | 124 (21.8) | 51 (9.0) | 321 (56.4) | 469 (82.4) | 452 (79.4) |
| Hispanic or Latina†† | 643 (40.0) | 275 (42.8) | 49 (7.6) | 122 (19.0) | 61 (9.5) | 396 (61.6) | 532 (82.7) | 481 (74.8) |
| White, non-Hispanic | 180 (11.2) | 81 (45.0) | 25 (13.9) | 39 (21.7) | 13 (7.2) | 98 (54.4) | 150 (83.3) | 148 (82.2) |
| Multiple, non-Hispanic | 124 (7.7) | 44 (35.5) | 8 (6.5) | 39 (31.5) | 9 (7.3) | 60 (48.4) | 105 (84.7) | 107 (86.3) |
| Other,§§ non-Hispanic | 89 (5.5) | 15 (16.9) | 6 (6.7) | 13 (14.6) | 6 (6.7) | 60 (67.4) | 66 (74.2) | 61 (68.5) |
| Gender identity¶¶ | ||||||||
| Woman | 509 (31.7) | 199 (39.1) | 57 (11.2) | 118 (23.1) | 37 (7.3) | 287 (56.4) | 431 (84.7) | 407 (80.0) |
| Man | 6 (0.4) | —*** | — | — | — | — | 5 (83.3) | — |
| Transgender woman | 1,404 (87.3) | 558 (39.7) | 131 (9.3) | 295 (21.0) | 126 (9.0) | 817 (58.2) | 1,144 (81.5) | 1,084 (77.2) |
| Transgender man | 11 (0.7) | — | — | — | — | 7 (63.6) | 9 (81.8) | 6 (54.6) |
| A gender not listed here | 94 (5.9) | 40 (42.6) | 12 (12.8) | 24 (25.5) | 7 (7.5) | 46 (48.9) | 74 (78.7) | 64 (68.1) |
| Currently has health insurance | ||||||||
| Yes | 1,337 (83.2) | 512 (38.3) | 120 (9.0) | 281 (21.0) | 104 (7.8) | 794 (59.4) | 1,178 (88.1) | 1,127 (84.3) |
| No | 270 (16.8) | 124 (45.9) | 32 (11.9) | 56 (20.7) | 36 (13.3) | 142 (52.6) | 146 (54.1) | 124 (45.9) |
| Unmet need for health care during the past 12 months | ||||||||
| Yes | 323 (20.1) | 186 (57.6) | 37 (11.5) | 97 (30.0) | 36 (11.2) | 147 (45.5) | 238 (73.7) | 224 (69.4) |
| No | 1,285 (79.9) | 451 (35.1) | 115 (9.0) | 241 (18.8) | 104 (8.1) | 789 (61.4) | 1,087 (84.6) | 1,027 (79.9) |
| Self-reported HIV status††† | ||||||||
| HIV–positive | 615 (38.3) | 229 (37.2) | 60 (9.8) | 139 (22.6) | 50 (8.1) | 350 (56.9) | 546 (88.8) | 537 (87.3) |
| HIV–negative or unknown | 991 (61.6) | 407 (41.1) | 92 (9.3) | 199 (20.1) | 89 (9.0) | 585 (59.0) | 778 (78.5) | 714 (72.1) |
| Education | ||||||||
| Less than high school | 347 (21.6) | 168 (48.4) | 35 (10.1) | 75 (21.6) | 33 (9.5) | 192 (55.3) | 283 (81.6) | 268 (77.2) |
| High school diploma or equivalent | 596 (37.1) | 247 (41.4) | 64 (10.7) | 136 (22.8) | 61 (10.2) | 326 (54.7) | 480 (80.5) | 447 (75.0) |
| Some college or technical degree | 486 (30.2) | 181 (37.2) | 40 (8.2) | 105 (21.6) | 33 (6.8) | 290 (59.7) | 416 (85.6) | 395 (81.3) |
| College degree or more | 177 (11.0) | 39 (22.0) | 13 (7.3) | 21 (11.9) | 12 (6.8) | 128 (72.3) | 144 (81.4) | 140 (79.1) |
| Annual household income, USD | ||||||||
| 40,000–74,999 | 173 (10.8) | 25 (14.5) | — | 9 (5.2) | 13 (7.5) | 145 (83.8) | 145 (81.8) | 140 (80.9) |
| 20,000–39,999 | 274 (17.0) | 78 (28.5) | 22 (8.0) | 42 (15.3) | 20 (7.3) | 186 (67.9) | 228 (83.2) | 218 (79.6) |
| 10,000–19,999 | 435 (27.1) | 155 (35.6) | 29 (6.7) | 83 (19.1) | 30 (6.9) | 274 (63.0) | 372 (85.5) | 358 (82.3) |
| ≤9,999 | 711 (44.2) | 373 (52.5) | 94 (13.2) | 201 (28.3) | 76 (10.7) | 324 (45.6) | 571 (80.3) | 523 (73.6) |
| Urban area | ||||||||
| Atlanta, Georgia | 132 (8.2) | 55 (41.7) | 12 (9.1) | 37 (28.0) | 18 (13.6) | 62 (47.0) | 88 (66.7) | 87 (65.9) |
| Los Angeles, California | 504 (31.3) | 224 (44.4) | 50 (9.9) | 136 (27.0) | 43 (8.5) | 270 (53.6) | 420 (83.3) | 374 (74.2) |
| New Orleans, Louisiana | 165 (10.3) | 77 (46.7) | 12 (7.0) | 35 (21.2) | 11 (6.7) | 106 (64.2) | 143 (86.7) | 136 (82.4) |
| New York, New York | 279 (17.4) | 114 (40.9) | 21 (7.5) | 46 (16.5) | 27 (9.7) | 181 (64.9) | 245 (87.8) | 222 (79.6) |
| Philadelphia, Pennsylvania | 220 (13.7) | 61 (27.7) | 13 (5.9) | 35 (15.9) | 19 (8.6) | 151 (68.6) | 174 (79.1) | 200 (90.9) |
| San Francisco, California | 198 (12.3) | 77 (38.9) | 39 (19.7) | 37 (18.7) | 15 (7.6) | 80 (40.4) | 179 (90.4) | 160 (80.8) |
| Seattle, Washington | 110 (6.8) | 29 (26.4) | 5 (4.6) | 12 (10.9) | 7 (6.4) | 86 (78.2) | 76 (69.1) | 72 (65.5) |
| Total | 1,608 (100) | 637 (39.6) | 152 (9.5) | 338 (21.0) | 140 (8.7) | 936 (58.2) | 1,325 (82.4) | 1,251 (77.8) |
Table 1. Structural and health care factors among transgender women (N = 1,608)* — National HIV Behavioral Surveillance System, seven U.S. urban areas, 2019–2020
Abbreviation: USD = U.S. dollars.
*Numbers might not sum to totals because of missing data.
†Homelessness was defined as having lived on the street, in a shelter, in a single room occupancy hotel, or in a car during
the past 12 months.
§Severe food insecurity was defined as not eating for a whole day because there wasn't enough money for food at some point
during the past 12 months.
¶Usual source of care was defined as having a place to go when sick or in need of health advice other than a hospital emergency
department.
**Because of racial and ethnic disparities in HIV prevalence, recruitment was focused on Black or African American and Hispanic
or Latina transgender women.
††Hispanic or Latina transgender women might be of any race.
§§Includes persons who indicated Asian, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander race.
¶¶Participants were asked to report their current gender identities from the following response options: woman, man, transgender
woman, transgender man, or a gender not listed here. All eligible participants reported a gender identity of "woman" or "transgender
woman;" however, participants were able to select more than one response option. Gender identities are not mutually exclusive.
***Dashes indicate suppression because of small cell size (<5).
†††Participants who reported having a previous positive HIV test result were defined as self-reported HIV–positive.
| Characteristic | No. of transgender women | Viral suppression | Current antiretroviral use | ||||
|---|---|---|---|---|---|---|---|
| No. (%) | aPR† (95% CI) | p-value | No. (%) | aPR† (95% CI) | p-value | ||
| Annual household income, USD | |||||||
| 40,000–74,999 | 51 | 45 (88.2) | 1.12 (1.00–1.25) | 0.043 | 48 (94.1) | 1.06 (0.99–1.15) | 0.107 |
| 20,000–39,999 | 94 | 83 (88.3) | 1.18 (1.09–1.27) | <0.001 | 88 (93.6) | 1.07 (1.01–1.14) | 0.023 |
| 10,000–19,999 | 177 | 129 (72.9) | 0.96 (0.87–1.05) | 0.365 | 165 (93.2) | 1.08 (1.02–1.14) | 0.012 |
| ≤9,999 | 290 | 209 (72.1) | Ref | — | 249 (85.9) | Ref | — |
| Education | |||||||
| Less than high school | 144 | 108 (75.0) | Ref | — | 130 (90.3) | Ref | — |
| High school diploma or equivalent | 236 | 171 (72.5) | 1.02 (0.92–1.12) | 0.735 | 210 (89.0) | 1.00 (0.95–1.05) | 0.967 |
| Some college or technical degree | 196 | 155 (79.1) | 1.08 (0.98–1.19) | 0.127 | 177 (90.3) | 1.02 (0.95–1.08) | 0.606 |
| College degree or more | 39 | 33 (84.6) | 1.18 (1.03–1.34) | 0.013 | 34 (87.2) | 0.98 (0.88–1.08) | 0.661 |
| Experienced homelessness§ | |||||||
| Yes | 265 | 179 (67.6) | 0.88 (0.81–0.96) | 0.003 | 226 (85.3) | 0.91 (0.88–0.96) | <0.001 |
| No | 350 | 288 (82.3) | Ref | — | 325 (92.9) | Ref | — |
| No. of nights homeless§ | |||||||
| 365 | 60 | 33 (55.0) | 0.75 (0.58–0.96) | 0.025 | 47 (78.3) | 0.84 (0.76–0.93) | 0.001 |
| 30–364 | 139 | 97 (69.8) | 0.91 (0.83–1.00) | 0.048 | 119 (85.6) | 0.92 (0.87–0.98) | 0.011 |
| <30 | 50 | 39 (78.0) | 1.02 (0.88–1.18) | 0.804 | 47 (94.0) | 0.99 (0.91–1.08) | 0.799 |
| None | 350 | 288 (82.3) | Ref | — | 325 (92.9) | Ref | — |
| Severe food insecurity¶ | |||||||
| Yes | 229 | 150 (65.5) | 0.84 (0.76–0.92) | <0.001 | 193 (84.3) | 0.92 (0.87–0.96) | 0.001 |
| No | 386 | 317 (82.1) | Ref | — | 328 (92.7) | Ref | — |
| Currently has health insurance | |||||||
| Yes | 560 | 435 (77.7) | 1.14 (0.96–1.35) | 0.133 | 507 (90.5) | 1.16 (1.03–1.30) | 0.016 |
| No | 54 | 32 (59.3) | Ref | — | 43 (79.6) | Ref | — |
| Unmet need for health care during the past 12 months | |||||||
| Yes | 90 | 58 (64.4) | 0.89 (0.81–0.99) | 0.027 | 74 (82.2) | 0.90 (0.84–0.97) | 0.008 |
| No | 525 | 409 (77.9) | Ref | — | 477 (90.9) | Ref | — |
| Has usual source of care** | |||||||
| Yes | 546 | 420 (76.9) | 1.07 (0.94–1.22) | 0.323 | 496 (90.8) | 1.16 (1.03–1.32) | 0.015 |
| No | 69 | 47 (68.1) | Ref | — | 55 (79.7) | Ref | — |
| Comfort with a health care provider†† | |||||||
| Yes | 537 | 423 (78.8) | 1.17 (1.04–1.32) | 0.007 | 490 (91.2) | 1.16 (1.05–1.29) | 0.004 |
| No | 78 | 44 (56.4) | Ref | — | 61 (78.2) | Ref | — |
| Total | 615 | 467 (75.9) | — | — | 551 (89.6) | — | — |
Table 2. HIV treatment among transgender women living with a positive HIV test result — National HIV Behavioral Surveillance System, seven U.S. urban areas,* 2019–2020
Abbreviations: aPR = adjusted prevalence ratio; Ref = referent group; USD = U.S. dollars.
*The seven urban areas include Atlanta, Georgia; Los Angeles, California; New Orleans, Louisiana; New York, New York; Philadelphia,
Pennsylvania; San Francisco, California; and Seattle, Washington.
†Adjusted for age, race and ethnicity, city, and network size and clustered on urban areas and recruitment chains.
§Homelessness was defined as having lived on the street, in a shelter, in a single room occupancy hotel, or in a car during
the past 12 months.
¶Severe food insecurity was defined as not eating for a whole day because there was not enough money for food at some point
during the past 12 months.
**Usual source of care was defined as having a place to go when sick or in need of health advice other than a hospital emergency
department.
††Comfort with a health care provider was defined as having a health care provider with whom the participant is comfortable
discussing gender-related health issues.
| Characteristic | No. of transgender women | HIV test in the past 12 months | PrEP use in the past 12 months | ||||
|---|---|---|---|---|---|---|---|
| No. (%) | aPR† (95% CI) | p-value | No. (%) | aPR† (95% CI) | p-value | ||
| Annual household income, USD | |||||||
| 40,000–74,999 | 122 | 93 (76.2) | 0.93 (0.85–1.01) | 0.099 | 23 (18.8) | 0.73 (0.53–0.99) | 0.043 |
| 20,000–39,999 | 180 | 136 (75.6) | 0.90 (0.82–0.98) | 0.022 | 55 (30.6) | 1.09 (0.90–1.32) | 0.377 |
| 10,000–19,999 | 258 | 214 (82.9) | 0.99 (0.94–1.04) | 0.640 | 96 (37.2) | 1.45 (1.22–1.74) | <0.001 |
| ≤9,999 | 421 | 358 (85.0) | Ref | — | 113 (26.8) | Ref | — |
| Education | |||||||
| Less than high school | 203 | 173 (85.2) | Ref | — | 51 (25.1) | Ref | — |
| High school diploma or equivalent | 360 | 283 (78.6) | 0.93 (0.86–1.01) | 0.067 | 110 (30.6) | 1.26 (1.02–1.56) | 0.033 |
| Some college or technical degree | 290 | 244 (84.1) | 1.00 (0.94–1.07) | 0.944 | 91 (31.4) | 1.27 (0.97–1.66) | 0.087 |
| College degree or more | 138 | 106 (76.8) | 0.95 (0.85–1.06) | 0.379 | 36 (26.1) | 1.06 (0.81–1.40) | 0.662 |
| Experienced homelessness§ | |||||||
| Yes | 406 | 349 (86.0) | 1.10 (0.99–1.21) | 0.076 | 126 (31.0) | 1.08 (0.93–1.25) | 0.332 |
| No | 586 | 458 (78.2) | Ref | — | 162 (27.6) | Ref | — |
| No. of nights homeless§ | |||||||
| 365 | 92 | 73 (79.3) | 1.03 (0.90–1.17) | 0.663 | 24 (26.1) | 0.98 (0.70–1.38) | 0.899 |
| 30–364 | 199 | 176 (88.4) | 1.12 (1.00–1.25) | 0.059 | 62 (31.2) | 1.05 (0.84–1.32) | 0.654 |
| <30 | 90 | 78 (86.7) | 1.10 (0.99–1.21) | 0.073 | 29 (32.2) | 1.09 (0.83–1.43) | 0.525 |
| None | 586 | 458 (78.2) | Ref | — | 162 (27.6) | Ref | — |
| Severe food insecurity¶ | |||||||
| Yes | 408 | 342 (83.8) | 1.02 (0.96–1.10) | 0.495 | 137 (33.6) | 1.23 (1.03–1.47) | 0.024 |
| No | 582 | 463 (79.5) | Ref | — | 149 (25.6) | Ref | — |
| Currently has health insurance | |||||||
| Yes | 777 | 638 (82.1) | 1.06 (0.98–1.16) | 0.155 | 240 (30.9) | 1.54 (1.26–1.88) | <0.001 |
| No | 216 | 170 (78.7) | Ref | — | 48 (22.2) | Ref | — |
| Unmet need for health care during the past 12 months | |||||||
| Yes | 233 | 190 (81.6) | 0.99 (0.93–1.05) | 0.792 | 60 (25.7) | 0.82 (0.68–1.00) | 0.050 |
| No | 760 | 618 (81.3) | Ref | — | 228 (30.0) | Ref | — |
| Has usual source of care** | |||||||
| Yes | 779 | 650 (83.4) | 1.16 (1.08–1.23) | <0.001 | 261 (33.5) | 2.54 (1.86–3.45) | <0.001 |
| No | 210 | 154 (73.3) | Ref | — | 26 (12.4) | — | |
| Comfort with a health care provider†† | |||||||
| Yes | 714 | 601 (84.2) | 1.12 (1.04–1.21) | 0.004 | 240 (33.6) | 1.79 (1.43–2.24) | <0.001 |
| No | 274 | 206 (75.2) | Ref | — | 48 (17.5) | Ref | — |
| Total | 991 | 786 (82.3) | — | — | 288 (29.0) | — | — |
Table 3. HIV prevention services among transgender women without known HIV infection — National HIV Behavioral Surveillance System, seven U.S. urban areas,* 2019–2020
Abbreviations: aPR = adjusted prevalence ratio; PrEP = preexposure prophylaxis; Ref = referent group; USD = U.S. dollars.
*The seven urban areas include Atlanta, Georgia; Los Angeles, California; New Orleans, Louisiana; New York, New York; Philadelphia,
Pennsylvania; San Francisco, California; and Seattle, Washington.
†Adjusted for age, race and ethnicity, city, and network size and clustered on urban areas and recruitment chains.
§Homelessness was defined as having lived on the street, in a shelter, in a single room occupancy hotel, or in a car during
the past 12 months.
¶Severe food insecurity was defined as not eating for a whole day because there was not enough money for food at some point
during the past 12 months.
**Usual source of care was defined as having a place to go when sick or in need of health advice other than a hospital emergency
department.
††Comfort with a health care provider was defined as having a health care provider with whom the participant is comfortable
discussing gender-related health issues.
This activity is intended for public health officials, women's health clinicians, infectious disease clinicians, internists, nurses, pharmacists, and other clinicians who treat and manage transgender women with or at risk for HIV.
The goal of this activity is for learners to be better able to describe HIV test results and factors associated with HIV prevention and health care use among transgender women, based on a study of 1,608 transgender women who participated in the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance in 7 US urban areas.
Upon completion of this activity, participants will:
Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.
Medscape, LLC designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number JA0007105-0000-22-218-H01-P).
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 9/26/2022
Valid for credit through: 9/26/2023, 11:59 PM EST
processing....
What is already known about this topic?
Transgender women are disproportionately affected by HIV.
What is added by this report?
During 2019–2020, 38% of transgender women surveyed in seven major U.S. cities reported receiving a previous positive HIV test result. Low income (44%), experiencing homelessness (39%), and severe food insecurity (40%) were common and associated with lower likelihood of receipt of HIV prevention and health care; having a health care provider with whom the participant is comfortable was positively associated with receiving those services.
What are the implications for public health practice?
Ensuring access to basic needs, such as housing, food, and income, and providing gender-affirming health care could improve access to and use of HIV prevention and treatment services by transgender women.
| « Return to: Factors Associated With Use of HIV Prevention and Health Care Among Transgender Women — Seven Urban Areas, 2019–2020 |
