Background : A 2015 Survey of Transgender adults in the U.S. found that one-quarter of respondents reported that they did not seek health care for fear of being mistreated as a transgender person. This fear is validated; the survey found that one-third of respondents had a negative experience related to being Transgender when seeing a health care provider. In light of the difficulty Transgender people experience with the health care system, the present study examines the data collection and verification process of gender identity in HIV Surveillance and other HIV services data systems. We use this data to understand the continuum of care for people living with HIV who are Transgender in Texas. We examine where the drop-offs in the care continuum are occurring for PLWH who are Transgender. In addition, we examine disparities in health outcomes within the Transgender community.
Methods : We used data from the HIV Surveillance system (eHARS) and electronic lab records (ELR). Texas has been collecting gender identity in the HIV Surveillance System since 2014. Through an identifier-based matching process, we linked the HIV surveillance data to other data sources containing Ryan White Services data, ADAP data, data from STD*MIS, prevention data, and survey data collected from the Texas Medical Monitoring Project and Houston Medical Monitoring Project. This matching process allows for verification of the gender identity information among PLWH. Matching to data sources containing services data allows for measurement of in-care status, retention in care, and viral suppression.
Results : In 2017, there were 700 PLWH who are Transgender in Texas. This includes 683 Transgender women and 17 Transgender men. Of the PLWH who are Transgender are predominantly Black (41%) or Latinx (43%), higher proportions compared to all PLWH in Texas. Increases in the numbers of PLWH and the increases in the numbers of newly diagnosed people who are Transgender are attributed to the inclusion of the gender identity field beginning in 2014. In 2017, 86% of PLWH who are transgender were in care with at least one medical visit or lab record, which is higher than the statewide average of 77%. At the end of 2017, 77% of transgender women were retained in care, again, higher than the statewide average 70%. These high proportions of in-care status and retention maybe partially be attributed to identifying the transgender population through HIV services data systems. At the end of 2017, 60% of PLWH who are Transgender were virally suppressed, which is matches the statewide average 60%. However, clear health disparities in viral suppression exist among Black Transgender women (54%) compared to Latinx (64%) and white Transgender women (61%).
Conclusions : Our findings indicate barriers to viral suppression among PLWH who are Transgender, specifically Black Transgender women. Collecting information on gender identity should be a priority for all healthcare providers and HIV care should be oriented to address HIV-related needs for PLWH who are Transgender at both individual and organizational levels. Addressing disparities in care patterns among marginalized groups is a national priority and may ultimately improve HIV outcomes.