Engagement and Retention in HIV Care for Transgender Women: Perspectives of Medical and Social Service Providers in New York City

• Published in: AIDS patient care and STDs Vol. 34; no. 1; p. 16
• Main Authors: Bockting, Walter, MacCrate, Caitlin, Israel, Hayley, Mantell, Joanne E, Remien, Robert H
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Cultural Competency; Female; Health Services Accessibility; Healthcare Disparities; HIV Infections - drug therapy; HIV Infections - psychology; Humans; Interviews as Topic; Male; New York City; Patient Acceptance of Health Care; Patient Compliance; Retention in Care; Social Stigma; Social Support; Social Work; Substance-Related Disorders - complications; Transgender Persons - psychology; Young Adult; New York City; access to care; retention in care; engagement in care; transgender
• ISSN: 1557-7449
• DOI: 10.1089/apc.2019.0067

Transgender women are less likely to engage in HIV care and adhere to antiretroviral medications than other at-risk populations. Health care and social service providers, in addition to consumers, have experiences that can elucidate barriers and facilitators to care and inform interventions. Guided by the social/ecological model, we conducted interviews with 19 providers working with transgender women. At the health systems level, perceived barriers included lack of care accessibility and security, providers' misunderstanding of the transgender community, and lack of cultural competency of information systems and staff. At the community level, barriers included HIV stigma. At the family level, barriers included rejection and housing instability. At the individual level, barriers included conflicts between HIV- and transgender care, medication side effects, competing priorities, mental health issues and substance abuse, and low health literacy. Facilitators included provider competence in transgender health, improved access to care, and patient empowerment. Findings indicate the need for an integrated care model.