Over two decades, about 80% of transgender women living with HIV had ever received HIV care, more than 70% were currently in care and nearly 60% had an undetectable viral load, according to a systematic review and meta-analysis published in the journal AIDS. There were not enough data on trans men to do a similar analysis for that population.
Behavioral scientist Jeffrey Becasen, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues went back through databases of HIV literature to find studies published on HIV outcomes among transgender people in the United States. Of the 50 selected studies conducted between 1997 and 2018, 41 had data the researchers considered the most reliable, while the rest were moderately reliable.
Altogether, more than 11,000 transgender people—mostly trans women—participated in the studies (though some people might have taken part in more than one). Most study participants were recruited from community organizations or clinics throughout the United States. Across the studies, the average age ranged from 21 to 51 years old.
Because not enough studies have been done on HIV outcomes among transgender men and nonbinary people, the researchers couldn’t conduct an analysis for these groups. However, they did synthesize what information was available. The two studies with data on trans men found that between 58% and 88% were currently taking antiretroviral treatment and 69% were taking it as prescribed. The studies didn’t provide data on how many men had an undetectable viral load.
In the studies of transgender women, the HIV care continuum breaks down like this: 79% had ever received HIV care, 71% were currently receiving care and 76% of those were retained in care. However, only 65% of transgender women were linked to care in a timely way, which the researchers defined as within three months of their diagnosis.
Regarding treatment, 70%) had ever been prescribed antiretroviral therapy, 72% were currently on treatment and 60% had good adherence. Among all trans women in the studies, 59% had an undetectable viral load on their last test, but looking just at those who were receiving care or on treatment, 73% had viral suppression.
These findings differ from CDC surveillance data for 2018 that showed that 88% of trans women diagnosed with HIV were linked to care within three months and 72% had an undetectable viral load on their last test. For comparison, the CDC estimates that 67% of diagnosed gay and bisexual men and 63% of cigsgender women achieved viral suppression in 2018.
This analysis didn’t include information about whether the trans women had access to gender-affirming services, such as hormones or surgery, both of which have been found to be associated with better HIV care and higher rates of viral suppression. Such integrated care may improve adherence seen in the analysis found.
“Integrating transgender-specific health needs (e.g., hormone therapy) into HIV care might be needed for improving the percentages of transgender persons across the HIV care continuum,” the authors wrote.
Click here to read the study abstract.