HIV-positive transgender men in US have significant unmet medical and social needs

HIV-positive transgender men in the United States have significant unmet social and healthcare needs, according to a study published in Research and Practice. Approximately half were living in poverty and only 60% had sustained viral suppression.

“Many transgender men receiving HIV medical care in the United States face socioeconomic challenges and suboptimal health outcomes,” write the authors. “Although these transgender men had access to HIV medical care, many experienced poor health outcomes and unmet needs.”

Transgender people experience poorer health outcomes compared to cisgendered individuals (people whose current gender identity is the same as the one with which they were born).

Little is known about characteristics and outcomes of HIV-positive transgender men (designated female at birth). A team of investigators therefore analysed the records of patient who received HIV care in the United States between 2009 and 2014. Their aim was to characterise the sociodemographic and clinical characteristics of these individuals.

Overall, transgender men constituted 0.16% of all adults but 11% of transgender adults receiving HIV care in the United States. The majority (59%) were aged between 18 and 49 years and 40% identified as gay or bisexual. Although 42% had completed high school, almost half (47%) had an income below the national poverty level. A third were uninsured or relied on a Ryan White programme for their health care. Over two-thirds (69%) had an unmet support need and a quarter were currently living with depression.

Most (53%) were sexually active.

The majority (57%) had been living with HIV for ten or more years; a quarter had a history of an AIDS diagnosis. The vast majority (93%) had ever taken antiretrovirals; 88% were on HIV therapy and 83% were fully adherent to their treatment. Last viral load measurement was undetectable in 69% and 57% had a current CD4 cell count above 500 cells/mm³. Two-thirds of people had a viral load test every six months but only 40% had received sexual health or HIV prevention counselling from a healthcare professional.

“More than 1 in 10 transgender persons receiving HIV care were transgender men. HIV-positive transgender men receiving medical care in the United States constitute a small group with socioeconomic challenges, unmet needs for supportive services, and poor health outcomes,” conclude the authors. “To decrease disparities and achieve health equity among HIV-positive men, HIV care models could incorporate transgender-sensitive health care and mental health services and health insurance inclusive of sex reassignment procedures and physical sex-related care.”