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Table 1.  

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.

Table 2.  

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.

Table 3.  

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.

CME / ABIM MOC / CE

Factors Associated With Use of HIV Prevention and Health Care Among Transgender Women — Seven Urban Areas, 2019–2020

  • Authors: Kathryn Lee, MPH; Lindsay Trujillo, MPH; Evelyn Olansky, MPH; Taylor Robbins, MPH; Christine Agnew Brune, PhD; Elana Morris, MPH; Teresa Finlayson, PhD; Dafna Kanny, PhD; Cyprian Wejnert, PhD
  • CME / ABIM MOC / CE Released: 9/26/2022
  • Valid for credit through: 9/26/2023
Start Activity

  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

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:

  • Assess the association of socioeconomic status and health care accessibility with health care use and outcomes among transgender women who reported a positive HIV test result, based on a study of National HIV Behavioral Surveillance data during 2019 to 2020
  • Evaluate the association of socioeconomic status and health care accessibility with HIV prevention among transgender women who did not report a positive HIV test result, based on a study of National HIV Behavioral Surveillance data during 2019 to 2020
  • Determine the clinical and public health implications of factors associated with HIV-related health outcomes and health care use among transgender women, based on a study of National HIV Behavioral Surveillance data during 2019 to 2020


Faculty

  • Kathryn Lee, MPH

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Kathryn Lee, MPH, has no relevant financial relationships.

  • Lindsay Trujillo, MPH

    Social & Scientific Systems, Inc.
    Atlanta, Georgia 

    Disclosures

    Lindsay Trujillo, MPH, has no relevant financial relationships.

  • Evelyn Olansky, MPH

    Social & Scientific Systems, Inc.
    Atlanta, Georgia 

    Disclosures

    Evelyn Olansky, MPH, has no relevant financial relationships.

  • Taylor Robbins, MPH

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Taylor Robbins, MPH, has no relevant financial relationships.

  • Christine Agnew Brune, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Christine Agnew Brune, PhD, has no relevant financial relationships.

  • Elana Morris, MPH

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Elana Morris, MPH, has no relevant financial relationships.

  • Teresa Finlayson, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Teresa Finlayson, PhD, has no relevant financial relationships.

  • Dafna Kanny, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Dafna Kanny, PhD, has no relevant financial relationships.

  • Cyprian Wejnert, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Cyprian Wejnert, PhD, has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie

Editor/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has no relevant financial relationships.


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CME / ABIM MOC / CE

Factors Associated With Use of HIV Prevention and Health Care Among Transgender Women — Seven Urban Areas, 2019–2020

Authors: Kathryn Lee, MPH; Lindsay Trujillo, MPH; Evelyn Olansky, MPH; Taylor Robbins, MPH; Christine Agnew Brune, PhD; Elana Morris, MPH; Teresa Finlayson, PhD; Dafna Kanny, PhD; Cyprian Wejnert, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 9/26/2022

Valid for credit through: 9/26/2023

processing....

Summary

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.

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