Understanding ART Adherence in Transgender People with HIV

Transgender and gender nonconforming (TGNC) people have a significantly increased risk of HIV infection. In 2015, the number of transgender people diagnosed with HIV was 3 times the national average. Transgender women have 49 times the odds of having HIV compared with the general population, and transgender men also have notably higher infection rates.

Antiretroviral therapy (ART) decreases morbidity, mortality, and transmission; therefore, ART adherence is critical to the health of TGNC patients with HIV. Understanding adherence patterns is the first step to combat the HIV epidemic in this population.

A recent study published in Transgender Health analyzed TGNC ART adherence based on the US Trans Survey (USTS), the largest survey of TGNC people in the United States. This large-scale evaluation, which reached TGNC people from many backgrounds, may provide more representative data than previous studies focusing on HIV patients connected to health care.

The researchers studied data from the 2015 USTS, in which 162 respondents reported an HIV diagnosis and ART prescription. Within this group, 66% of respondents were classified as adherent, and 34% were considered nonadherent. The researchers then studied how other factors—including race, living arrangements, sex work history, and substance use—differed in adherent vs. nonadherent populations.

A higher proportion of whites and Hispanics were adherent compared to black individuals. Adherent individuals reported higher rates of home ownership, while nonadherent individuals were more likely to report “other” living conditions, such as roommate situations, and homelessness. Additionally, nonadherent participants reported higher rates of verbal harassment, sex work, and illegal/illicit drug use in the past year, and lower rates of seeing a doctor due to cost in the past year.

These findings support previous data that social determinants of health play a critical role in ART adherence and HIV outcomes. One particularly high-priority population may be black TGNC individuals, who report both higher HIV rates, and lower adherence rates. Vulnerable TGNC populations in unstable sociostructural conditions, such as homelessness, sex work, and drug use, are more prone to nonadherence.

As accessible, approachable health care workers, community pharmacists have both opportunity and responsibility to counsel at-risk patients regarding ART adherence. This may prove to be a critical step to improve health outcomes, and decrease health disparities in this vulnerable population.

May Zhang is a 2022 PharmD Candidate at the University of Connecticut in Storrs.

REFERENCE

Teti M, Bauerband LA, Altman C. Adherence to Antiretroviral Therapy Among Transgender and Gender Nonconforming People Living with HIV: Findings from the 2015 U.S. Trans Survey. Transgend Health. 2019;4(1):262—269. Published 2019 Oct 25. doi:10.1089/trgh.2019.0050