Trans Women: Both Bias Crimes and ART-Adherence Rates Up

Despite very high rates of anti-gay discrimination and violence, new research indicates that HIV-positive transgender people are just as likely to stay in care, take their meds and have similar outcomes as other PLWHAs.

A study from the Perelman School of Medicine at the University of Pennsylvania published on May 30 in the publication Clinical Infectious Diseases looked at 37,000 patients at 13 U.S. HIV clinics from 2001-2011. It suggested an encouraging shift from earlier studies that reported a poor retention in care and drug adherence in transgender people, a high risk group for HIV.

"It's a combination of things: there have been great advances in HIV therapy and management over the last decade and increased attention from advocates and groups on identifying people infected with HIV quickly, linking them to care in a timely fashion, and starting treatment earlier," said Baligh R. Yehia, MD, MPP, MSHP, a clinical instructor in the division of Infectious Diseases at Penn Medicine. "In addition, there is an increased focus on lesbian, gay, bisexual, and transgender (LGBT) health in general."

In the retrospective analysis, Yehia found that transgender people receiving care had similar rates of retention, antiretroviral therapy (ART) coverage and HIV suppression as non-transgender men and women over the 10-year period.

Several factors could explain why care and suppression rates have improved and become more equal, including advances in HIV therapy and management and increased attention on early detection, care and treatment. Yehia said that there is also an overall increased focus on LGBT healthcare.

"Over the past five years, leading federal institutions and national organizations...have emphasized the importance of improving the health of LGBT populations by understanding and addressing their unique health care needs, identifying research gaps and opportunities, and developing educational activities to address the needs of LGBT trainees, faculty, staff and patients," he said.

For the study, Yehia and colleagues, including Kelly A. Gebo, MD, MPH, of the Johns Hopkins University School of Medicine, retrospectively looked at 36,845 patients from 13 clinics within the HIV Research Network, a consortium that cares for HIV-infected patients across the nation, from 2001 to 2011. Of the group, 285 self-identified as transgender.

Researchers found rates nearly equal between men, woman and transgender persons in care, ART and HIV suppression. Transgender patients were more likely to be young and Hispanic. They also tended to have sex with the high-risk group of men who have sex with men, and be among the highest risk for HIV infections, along with blacks and Hispanics. In 2009, the Centers for Disease Control and Prevention reported newly-identified HIV infection rates of 2.9 percent for transgender persons compared to 0.9 percent for non-transgender males and 0.3 percent for females.

Past studies in the transgender population have documented decreased engagement in care, low ART coverage, and poor adherence to medication. But Yehia notes that seeking care from providers familiar with issues of gender identity and hormone replacement therapy can help improve safety.

"Many physicians don't feel comfortable taking care of transgender individuals because they are unfamiliar with their specific health needs and concerns," said Yehia, who also serves on the AMA LGBT advisory committee. "We have a come a long way, but more needs to be done. We need more education and research to help fill this knowledge gap and improve familiarity with transgender health issues."

Hate Violence Disproportionately Targets Transwomen of Color

Despite better advocacy and more comprehensive health care, transgender individuals -- particularly transwomen of color -- are disproportionately targeted for hate crimes, according to a 2012 report by the National Coalition of Anti-Violence Programs (NCAVP). The report analyzes statistics on survivors of violence from 18 states; it indicates that last year recorded the fourth-highest murder rate of LGBTQ and HIV-affected people in history.

The overall LGBTQH homicide rate actually decreased by 16.7 percent from 2011, which had the highest homicide rate of all time. But those most likely to experience hate violence included transgender people, particularly transgender women of color, and gay men. Young people, homeless people and people with disabilities were also disproportionately represented. LGBTQ people of color represented 53 percent of total reported survivors and victims of all hate crimes, but 73.1 percent of homicide victims. In all reported homicides involving transgender people, the victims were women.

The percentage of reported disabled survivors and victims skyrocketed from 11 to 40 percent from 2011 to 2012, a dramatic increase that can probably be attributed to more accurate reporting of disability than in previous years.

This report, as well as the recent string of violent hate crimes in New York, is a reminder that violence against the LGBTQH community, and particularly marginalized groups within that community, is an ongoing problem which is too urgent to ignore.

"Anti-LGBT violence is a reminder that our work in the LGBT community isn't done," said GLAAD National Spokesperson Wilson Cruz. "GLAAD is dedicated to elevating the stories of real people behind these statistics as a way to educate the media until violence against the LGBT community, and particularly transgender women of color, is completely eliminated from our society."

For more information, read the NCAVP's annual Hate Violence Report.