Today, The Fenway Institute of Fenway Health released a policy brief, Retaining transgender women in care: Best practices in the field, outlining provider best practices and innovative programs that result in higher rates of adherence to prescribed treatments among transgender women living with HIV. Transgender women, particularly Black and Latina women, are disproportionately vulnerable to HIV infection but less likely than other populations to receive regular medical care and adhere to their HIV medications.
“Transgender women of all racial and ethnic backgrounds are 49 times more likely to be living with HIV than the general population. Black and Latina transgender women are especially vulnerable,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute and a co-author of the brief. “HIV treatment adherence is lower for transgender women. This is an urgent crisis and requires action.”
The brief outlines the many barriers to healthcare experienced by transgender women, including a lack of health insurance, a deep reluctance to seek care as a result of prior mistreatment within the healthcare system, fear of anticipated mistreatment and stigma, and an erroneous belief that antiviral HIV medications will negatively impact hormonal therapy, or vice versa.
“One of the easiest interventions is simply showing representation of transgender people in the healthcare setting with brochures and signs, or even better, hiring transgender staff. This sends a message that transgender women are welcome and valued in that clinic,” Cahill said. “Patients should also be able to confidentially inform their healthcare provider of their gender identity.”
Other practices that can increase adherence to care include taking a trauma-informed approach with patients. In doing so, providers place a high priority on cultivating trust and being transparent in an attempt to mitigate past traumas experienced in the healthcare system or in society more broadly.
Additional practices of community-based retention in care interventions from the Special Projects of National Significance (SPNS) initiative are also highlighted in the brief. The Féminas project in Lima, Peru, a collaboration among IMPACTA and EPICENTRO in Lima, and The Fenway Institute in Boston, is also described. Best practices used successfully in these projects include offering care regardless of an ability to pay; employing transgender peer advocates to work with patients; integrating HIV care with gender-affirming healthcare; and incorporating healthcare within a broader array of services including assistance with housing, legal assistance, and help finding employment.
“Transgender women living with HIV have complex needs,” said Cahill. “We encourage those providing care to transgender women to adopt these best practices to improve health outcomes for transgender people living with HIV.”
The issue brief is based on a technical assistance webinar that Cahill conducted in 2017 with the National Association of State and Territorial AIDS Directors (NASTAD) and staff from health departments in San Antonio, Texas; Memphis, Tennessee; and New York City. Cahill co-authored the brief with Connor Volpi, a Research Fellow at The Fenway Institute in 2017.
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