Transgender women living with HIV face many barriers that can prevent them from finding and remaining in care, and they are less likely than other populations to adhere to their antiretroviral medications.
The Fenway Institute published a guide on how providers can help trans women living with HIV remain in care and achieve better health outcomes. The guide explores the barriers that these patients face and the ways that healthcare professionals might help patients overcome them. The guide mentions discrimination and violence victimization, representation, financial barriers, and perceived negative effects of mixing hormone therapies and antiretroviral medications as some of the main reasons that patients might not continue care.
The guide provides suggestions for overcoming each of these barriers:
Discrimination and violence victimization
Transgender women are disproportionately the victims of hate violence and overall have less confidence than other patient populations in medical professionals’ ability to integrate HIV-treatment into their lives. The guide suggests that providers take a trauma informed approach with trans patients, which “places importance on the safety of the individual and attempts to cultivate a high level of trust and transparency with the patient.” Some other practical suggestions include changing intake forms so that patients can self-disclose both assigned sex at birth and gender identity and asking patients for preferred name, as this may differ from legal name.
Trans representation in healthcare settings can be an important way to make trans patients feel comfortable there. The guide suggests that providers include physical illustrations and signals, like rainbow flags and LGBT-specific pamphlets, that indicate that the practice treats individuals of all sexual orientations and gender identities. There is also a need for trans representation in research, and the results of such research should be communicated to the patients who it can benefit.
Transgender people have higher rates of joblessness and poverty than cisgender people, so many trans women suffering from HIV may not have insurance to cover needed treatments. The guide indicates that there are not very many health centers that operate on a sliding scale, which limits the locations that these patients may be able to access. Further, for trans women who engage in sex work or other jobs without traditional hours, patients may not be able to make typical office hour appointments and may not get health care at all. The guide recommends that clinics offer alternate appointment slots and provide convenient transportation options so that these financial and logistical barriers do not interfere with trans women obtaining health care.
Hormones and antiretroviral medications
Many trans women worry that antiretroviral therapy will negatively affect hormone therapy and therefore show decreased adherence to their prescribed medications. The guide notes that previous studies have demonstrated that it is unlikely that the two medications interact, so providers should communicate this information to patients who may believe otherwise. Providers should still monitor for excess or deficient estrogen, as protease inhibitors may have these effects; this monitoring should improve compliance with medication regimens.
Ultimately, the guides suggests including HIV treatment in a broader context of “affirming, competent transgender health care.” This might require additional education and training for providers in either of those areas, but it should improve health outcomes for the many trans women who indicated that they’d like to receive co-delivered services for their hormonal and antiretroviral needs.
You can access the full guide from The Fenway Institute here: http://fenwayhealth.org/wp-content/uploads/TFIR46_RetainingTransgenderWomenInHIVCare_BestPractices_webready.pdf
You can learn more about the LGBTQ competency training services offered by QSPACES here: https://www.qspaces.org/lgbtq-training/