A Comparative Analysis of Socio-Behavioral and Health Experiences Among Transgender Women Living with and Without HIV

Purpose: This study aimed to compare social determinants of health, gender affirmation, sexual health resource access, and health characteristics among transgender women living with and without human immunodeficiency virus (HIV) in the Atlanta cohort of the Leading Innovation for Transgender Women’s Health and Empowerment study. Methods: Participants were recruited and enrolled between March 2018 and August 2020. The baseline study visit included a socio-behavioral survey, HIV testing, and sexually transmitted infection testing. Descriptive statistics were calculated, and age- and race-adjusted logistic regression models were fit, assessing associations between participant characteristics, including social determinants of health, gender affirmation, sexual health resource access, health, and biomarker-confirmed HIV status (dependent variable). Results: Of 131 participants, 37.4% ( N = 49) were living with HIV and 62.6% ( N = 82) were living without HIV. Several measures of health care access and sexual health support, including having had at least one individual interaction with an outreach worker or counselor (adjusted odds ratio [aOR] 2.5, 95% confidence interval [CI]: 1.1–5.9), were positively associated with living with HIV. Adverse mental health-related experiences, including suicidal ideation (aOR: 0.3, 95% CI 0.1–0.6) and history of physical violence (aOR 0.3, 95% CI 0.1–0.7), were inversely associated with living with HIV. Conclusions: Transgender women in Atlanta with gender affirmation, health care access, and fewer adverse mental health-related experiences were more likely to be living with HIV than without HIV. Further studies are needed to explore how organizational resources allocated for people living with HIV may explain these findings and the potential implications of expanding resources to transgender women living without HIV.