Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom.
This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology.
We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care.
We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services.
There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.
Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care
CTAC (Canadian Treatment Action Council), 2018
This project explored what issues impact engagement by people living with HIV with healthcare in Ontario. The goal was to identify policy issues that impact treatment access for people living with HIV, and to identify opportunities to make the healthcare system more accessible.
The HIV Cascade of Care is a useful description of the different steps that a person living with HIV will need to take in order to achieve an undetectable viral load and optimal health outcomes, from infection and diagnosis through to Antiretroviral Therapy (ART) initiation and viral suppression.
We know people drop out of the HIV Cascade of Care – e.g. why those starting treatment don’t stay on it. By seeking out policy barriers and developing solutions we can enable people to live long, healthy, and happy lives.
The project has five recommendations around barriers to engagement in the HIV Cascade of Care.
A new study suggests that the most beneficial age for a one-time screening HIV test of the general population would be age 25.
The report — led by researchers at Massachusetts General Hospital working with the U.S. Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Public Health — will be published in the Journal of Adolescent Health and has been issued online.
The NSW Ministry of Health (NSW MoH) requested Positive Life NSW (PLNSW) produce a discussion paper which explored the future service needs of people living with HIV (PLHIV) in NSW with complex care needs, in relation to HIV specialists and mainstream services.
The main lines of inquiry which PLNSW investigated were:
Access to Service Provision – where PLHIV obtained their primary health care and why they preferred to use a particular service; (p7-8)
Service Satisfaction – how satisfied PLHIV were with the services they received; (p7)
Health Care Service Barriers – what concerns or difficulties PLHIV experienced when accessing health care services; (p15-17)
PLHIV Criteria for Service Access – what were the considerations for accessing health care; (p14)
Mainstream Service Barriers – if PLHIV experienced difficulties or challenges when referred to mainstream or specialist services, what they might be, and; (p19)
Factors of Retention in Care – factors relating to the ability of PLHIV to remain engaged in treatment and care (p21).
Clin Infect Dis. 2016 Jun 25. pii: ciw416. [Epub ahead of print]
Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis
Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID’s engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID.
We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic.
We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25).
These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.
Less than a quarter of people taking part in clinical trials for antiretroviral medications are women, potentially limiting the generalisability of findings, according to a systematic review published in the February 1 edition of the Journal of Acquired Immune Deficiency Syndromes.