Background : HIV engagement in care and adherence to medication among trans women has been documented as significantly lower than other at-risk groups, even in countries providing universal care free of charge, such as Brazil. Using baseline data from a pilot intervention study called Trans Amigas, we sought to examine predictors of poor adherence to HIV medications in order to ensure that our programming, which includes a peer-navigation intervention and group activities for HIV-positive transgender women (TWG) in São Paulo, can address predictors of poor health.
Methods : Between May 2018 and December 2018, we enrolled 113 HIV-positive trans women in the Trans Amigas program. Among 107 with complete baseline data (at the time of this abstract), 85 had linked to care and reported on HIV medication adherence at baseline. We defined adherence based on self-reported survey items, including taking a minimum of 90% of prescribed ART medications. We used simple bivariate statistics to assess associations with various demographic, behavioral and structural indicators, including age, education, race, income, stable housing, alcohol use, drug use, depression, and stigma.
Results : Overall, 58% of participants in the analysis (n=49) reported being adherent to medication. Nonadherence was associated with younger age, lower income, unstable housing, and drug use. While alcohol use was not associated with adherence in this small sample, trends indicated that it may be an important factor. Drug use was also highly associated with instable housing, implying syndemic conditions.
Results will be updated using the full data set prior to the conference.
Conclusions : This is one of the first studies to examine adherence to ART among TGW. ART adherence among transwomen in our study is far below that of other populations in Brazil (ranging from 63 – 79%). In our findings, structural and social factors were highly associated with adherence. In a population with social barriers to care, including unstable housing and drug use, more traditional demographic risk factors, including race and education, play a less significant role in engagement to care. Projects must address social and structural barriers to care, including housing and harm reduction, if progress towards viral suppression and equal access to care is to be made.