HIV-Infected Transgender Women Less Adherent to Medications

Study finds greater unmet needs for basic services compared with male patients.

The difficulties of managing treatment for HIV are magnified among transgender female patients, according to a recent study.

An analysis by the US Centers for Disease Control and Prevention (CDC) found transgender women are significantly less adherent to their treatment regimens and as a result are less likely to achieve viral suppression. The results further showed that transgender women have higher unmet needs for basic services, including food and housing, than non-transgender men have.

The study, published online recently in LGBT Health, showed that transgender women infected with HIV were more marginalized socioeconomically than were non-transgender patients infected with HIV.

Approximately 1.3% of HIV-infected patients in the United States identified themselves as transgender women. There were no differences found among the percentages of transgender women and non-transgender men and women prescribed antiretroviral therapy (ART).

There was found to be a significantly lower percentage of transgender women compared with non-transgender men who achieved 100% ART dose adherence (78.4% vs. 87.4%) and viral suppression (50.8% vs. 61.4%).

"The fact that, compared to other groups in treatment, transwomen had less ART adherence and viral load suppression but more unmet needs for supportive services requires follow-up studies to inform remedial actions," LGBT Health Editor-in-Chief William Byne, MD, PhD, said in a press release.

The combined effect of all these factors are associated with discrepancies in ART adherence and viral load suppression, the study noted.

In excess of 80% of transgender women were identified as non-white with an annual income of less than $20,000. It was also found that more than 20% of transgender women are homeless and more than 30% did not have health insurance.

Approximately one-third of transgender women indicated injection or non-injection drug use. Meanwhile, less than 50% reported being sexually active, while 17.5% reported having unprotected vaginal or anal sex with a partner who is HIV-negative or of an unknown status.

“We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services,” the authors concluded. “However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.”