HIV in Diverse Populations
People with HIV from diverse populations face unique challenges, in addition to the basic challenges HIV presents. Here, we’ll discuss two diverse populations and shine a light on some of the issues they may frequently encounter.1
HIV in Diverse Populations | Transgender Women
“I am not a man; I don’t want to be treated like one,” said a participant in the focus group study Barriers and Facilitators to Engagement and Retention in Care Among Transgender Women Living with HIV.2
The study, authored by Jae M. Sevelius and others, indicates that transgender women are among the groups most affected by HIV,2 and are among the least researched. This imbalance can also be seen with respect to treatment. For instance, when it comes to managing HIV with antiretroviral therapy (ART), research shows that transgender women are less likely to be on treatment.
As of 2019, an estimated 14% of transgender women, living in a high-income country like the United States, had been diagnosed with HIV.3 And for African-American transgender women, the rate is higher–44%–compared with 7% of white transgender women and 26% of transgender Latinas.3
The Importance of Gender Affirmation
Some transgender women reported avoiding HIV testing sites that serve gay men because the sites were seen as insensitive to transgender women,2 compromising their needs by simply classifying them as MSMs (men who have sex with men). In addition, they felt their gender identity wasn’t being respected simply because of the name on their ID card.2
This fear of “transphobic” healthcare also applies to HIV care providers. Finding a trans-sensitive doctor (as well as his or her staff)2 was identified as a necessity for transgender women living with HIV. If they don’t have an HIV doctor who’s also familiar with transgender care, concerns about proper hormone doses, as well as interactions with HIV medications, this could lead to missed doses and confusion.4
Overall, transgender people face competing priorities that can impact their decision to begin and adhere to ART.2
For instance, people who are early on in their transition may fear drug interactions between their antiretroviral medicines and their hormone therapy.2 Several HIV-positive transgender women said that if forced to choose between hormone therapy and ART, they would choose hormone therapy,2 fearing that antiretrovirals would slow down the effects of hormones early on in their transition. Not surprisingly, too, adherence was found to be much lower among transgender people due to the difficulty of integrating treatment regimens into their daily life and the lack of positive experiences with their healthcare team.2 It’s clear that transgender women living with HIV may need some extra, thoughtful attention2 from their ASOs and healthcare providers so that they feel included, cared for, and supported.
HIV in Diverse Populations | The Hispanic/Latino Community
In 2016, Hispanics/Latinos made up almost 26% (10,292) of all estimated new diagnoses of HIV in the United States and 6 dependent areas.* Of those, 87% were men.5 Eighty-five percent of newly diagnosed cases in Latino men were attributed to male-to-male sexual contact.5
The vast majority of diagnoses in Hispanic women/Latinas living with HIV were from heterosexual contact.5 However, from 2011 to 2015, diagnoses among these women decreased by 14%.5
*American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
SOME CONTRIBUTING FACTORS OF HIV IN DIVERSE POPULATIONS:
Because of cultural influences, discrimination, and/or stigma, some Hispanics and Latinos may be hesitant to seek counseling or treatment if they are HIV-positive.5 While it may be tempting for them to shut down and keep the information to themselves, sharing their HIV status with somebody they trust and who understands their fear of being isolated from family and community can be helpful. That somebody could be you—and, of course, a healthcare provider who understands your clients’ challenges and can help them manage their HIV.5
Data show that Hispanic and Latino individuals often choose sexual partners of the same race or ethnicity. Because of high rates of HIV in the Hispanic/Latino communities, the risk of HIV infection among these individuals is much higher.5
SEXUALLY TRANSMITTED DISEASES (STDs)
Studies have pointed to higher rates for STDs (including chlamydia, gonorrhea, and syphilis) among Hispanics/Latinos compared with other races/ethnicities. And the presence of another STD has been linked to increased potential to become infected with HIV.5
ECONOMIC AND SOCIAL FACTORS
Some statistics have linked poverty, a lower education level, limited access to healthcare, and even potential language barriers as possible contributors to HIV among Latinos. These factors have been found to reduce awareness about risks and opportunities for testing and care.5
Many undocumented Hispanic/Latino immigrants may avoid seeking HIV prevention or care from a doctor/provider or going to a testing site for fear of their immigration status being revealed.5
HIV IN DIVERSE POPULATIONS, SIMILAR STIGMA:
One common thread across all the diverse groups living with HIV is the stigma.5,6 All have expressed experiencing instances of discrimination and other intolerance-driven behavior, often causing individuals to hide their identities and sexual orientation for fear of being treated as unwelcome by healthcare teams.2 Statistics show that as a result, they’re less likely to seek out HIV services6 and may be prone to depression, feelings of isolation, and helplessness.7 These feelings can interfere with their ability to cope with HIV and further impact their adherence to medications.5
1. Health disparities in HIV/AIDS, viral hepatitis, STDs, and TB. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchhstp/healthdisparities/default.htm. Updated March 14, 2014. Accessed July 19, 2019.
2. Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47:5-16. doi:10.1007/s12160-013-9565-8.
3. HIV and transgender people. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/group/gender/transgender/index.html. Updated June 4, 2019. Accessed July 19, 2019.
4. Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(suppl 3):S235-S242. doi:10.1097/qai.0000000000001088.
5. HIV and Hispanics/Latinos. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/. Updated November 1, 2018. Accessed July 19, 2019.
6. HIV and transgender people. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/pdf/group/gender/transgender/cdc-hiv-transgender-factsheet.pdf. Published April 2019. Accessed July 19, 2019.
7. Mental health. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/basics/livingwithhiv/mental-health.html. Updated July 25, 2018. Accessed July 19, 2019.
HVUWCNT190045 August 2019