Transgender New Yorkers living with HIV who received gender-affirming surgery through Medicaid saw their viral load drop in the years following surgery, according to data presented at the Conference on Retroviruses and Opportunistic Infections.
Epidemiologist Cristina Rodriguez-Hart, PhD, of the New York City Department of Health and Mental Hygiene, and colleagues identified 185 HIV-positive transgender adults in New York City who had access to Medicaid between 2013 and 2017 and had available viral load results. Medical codes in their charts showed they’d received top or bottom surgeries during that time.
Viral suppression rose among transgender people with HIV on Medicaid overall between 2013 and 2017, reaching 75%. What’s more, rates of viral suppression were higher among those who also had gender-affirming surgeries through Medicaid. It was an impressive climb, from 66% two years before surgery to 77% one year before to 86% a year after surgery. By two years out, 88% still had an undetectable viral load.
One year after surgery, 92% of people who received top surgery had an undetectable viral load. People who had bottom surgery had marginally higher rates of viral suppression before surgery but saw their rate dip to 84% one year after surgery. However, they were expected to reach 90% viral suppression by two years out.
The surgery itself didn’t necessarily lead to an undetectable viral load, according to Rodriguez-Hart, who noted that any number of factors could contribute to viral suppression in people receiving surgery. For instance, it could be that receiving the care one needs from professionals trained to work with transgender people could have built trust in a health care system that has often misgendered and otherwise mistreated people of trans experience.
“This is all the more reason why [transgender people living with HIV] need more support,” she said, “so that they can obtain better overall health and obtain affirming surgeries.”