Treatment as Prevention (TasP) among black transgender women (BTW) in the United States: characterizing the HIV care continuum and identifying correlates of HIV diagnosis and care

Public Health Significance: Treatment as prevention (TasP) could be an effective way to address the HIV epidemic among Black transgender women (BTW) in the United States. For TasP to be effective in this population, more information regarding the manifestation of HIV care continuum outcomes among BTW is needed. Methods: Data came from Promoting Our Worth, Equality, and Resilience (POWER). In 2014 and 2015, POWER recruited Black men who have sex with men (BMSM) and BTW who attended Black Pride events in Philadelphia, PA, Houston, TX, Washington, D.C., Detroit, MI, Memphis, TN, and Atlanta, GA. A total of 245 BTW provided complete data for our analysis. Results: We detected an HIV prevalence rate of 37.8%. Of the 92 HIV-positive BTW, 50% had prior knowledge of their HIV-positive status. 100% of those with prior knowledge of their HIV-positive status reported that they were linked to HIV medical care. 93% of HIV-positive BTW linked to HIV medical care reported that they were retained in HIV medical care, and 95% of those retained in HIV medical care reported that they had been prescribed antiretrovirals (ARVs). 68% of the 41 HIV-positive BTW prescribed ARVs reported that they had an undetectable viral load. Health outcomes associated with HIV care in other populations were not associated with HIV diagnosis or viral suppression in our sample. Conclusion: Developing and implementing interventions that address testing uptake may assist in informing the HIV disparity among BTW in the United States. More research is needed to identify and understand the structural, community, and individual-level barriers and facilitators that shape BTW’s engagement in HIV medical care

Discrimination, Coping, and Depression among Black Men Who Have Sex with Men

Black men who have sex with men (BMSM) have elevated risk for depression compared to the general population. BMSM’s capacity to cope with these experiences is not well understood. Increased understanding of how multiple forms of discrimination contribute to depression and how BMSM cope with discrimination can better inform interventions. Data come from 3,510 BMSM who attended Black Pride events in six U.S. cities from 2015-2017. Participants completed a health survey that ascertained their psychosocial health and resiliency profiles. Using multivariable logistic regression models, we tested the associations between type-specific discrimination (race, sexuality, HIV status) and depression. We then conducted sub-analyses to determine if coping attenuated the association between type-specific discrimination and depression. Our findings indicated that increased odds of depression among BMSM were associated with discrimination based on race (aOR=1.38, 95% CI = 1.08-1.76), sexual orientation (aOR=1.32, 95% CI = 1.01-1.72), and HIV status (aOR=1.53, 95% CI = 1.08-2.17). Sub-analyses indicated coping had inconsistent moderation effects between type-specific discrimination and depression. Our findings demonstrate that impact of various forms of discrimination on BMSM’s mental health and the mitigating role of coping. Interventions should seek to address depression by reducing experiences of discrimination and building coping resiliency

Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-Related Diagnoses Utilizing Veterans Health Administration Care

Objectives: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. Methods: This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Results: Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. Conclusions: This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research