HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS Program: A retrospective study

Autoři: Pamela W. Klein aff001;  Demetrios Psihopaidas aff001;  Jessica Xavier aff002;  Stacy M. Cohen aff001
Působiště autorů: Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America aff001;  Independent Consultant, Silver Spring, Maryland, United States of America aff002
Vyšlo v časopise: HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS Program: A retrospective study. PLoS Med 17(5): e32767. doi:10.1371/journal.pmed.1003125
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003125



In the United States, approximately one-fifth of transgender women are living with HIV—nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men.

Methods and findings

We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92–0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41–0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42–0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care.


In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.

Klíčová slova:

Health services administration and management – HIV – HIV diagnosis and management – HIV epidemiology – Medicare – Socioeconomic aspects of health – Transgender people – Women's health


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