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Characterizing the HIV Care Continuum and Identifying Barriers and Facilitators to HIV Diagnosis and Viral Suppression Among Black Transgender Women in the United States

Bukowski, Leigh A., MPH*,†; Chandler, Cristian J., PhD*,†; Creasy, Stephanie L., MPH*,†; Matthews, Derrick D., PhD‡,†; Friedman, Mackey R., PhD‡,†; Stall, Ronald D., PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2018 - Volume 79 - Issue 4 - p 413–420
doi: 10.1097/QAI.0000000000001831

Background: Although black transgender women (BTW) experience high prevalence of HIV in the United States, no characterization of the HIV care continuum exists for this population. This study addresses this gap by (1) characterizing the HIV care continuum, and (2) exploring correlates of HIV diagnosis and viral suppression among a community-based sample of BTW.

Methods: Data came from Promoting Our Worth, Equality, and Resilience (POWER). From 2014 to 2017, POWER recruited BTW who attended Black Pride events in 6 U.S. cities. Participants completed a behavioral health survey and were offered onsite HIV testing. Simple frequencies were used to characterize the HIV care continuum, and multivariable logistic regression analysis was used to identify correlates of HIV diagnosis and viral suppression.

Results: A total of 422 BTW provided completed data for our analysis, 45.0% of whom were living with HIV. Over half of the HIV-positive BTW (51.4%) reported being undiagnosed at the time of survey, and 24.5% reported viral suppression. Incarceration and a lack of access to medical care were significantly and positively associated with an undiagnosed HIV-positive status in multivariable models. Incarceration, homelessness, polydrug use, physical assault, intimate partner violence, and current hormone use were significantly and negatively associated with viral suppression in multivariable models.

Conclusions: Developing and implementing interventions that address timely HIV diagnosis may assist in informing the HIV disparity among BTW in the United States. Interventions should address the fundamental causes of poor health in this population.

*Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA;

Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and

Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Leigh A. Bukowski, MPH, Department of Behavioral and Community, Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 (e-mail:

Supported in part by the National Institute for Nursing Research (R01NR013865).

The authors have no conflicts of interest to disclose.

Received February 23, 2018

Accepted July 02, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.