Healthy Bodies, Healthy Minds: Improving Medical and Mental Health Outcomes across the HIV Care Continuum for Young Transgender Women

Statement of Problem

Male-to-female transgender youth, or young transgender women, face many challenges to their physical and emotional well-being, including homelessness, joblessness, victimization, increased suicidality, and alarming rates of HIV infection, reported to be approximately 25% according to a recent meta-analysis. Additionally, among transgender individuals who meet DSM-V criteria for Gender Dysphoria, the prevalence of mental illness, including depression and anxiety, has been estimated to be as high as 62%. Recent data also show that youth in general have worse health outcomes throughout the course of HIV treatment when compared to adults, including low rates of diagnosis, connection to resources, retention in care, antiretroviral therapy (ART) prescription, and viral suppression. It is unclear how psychiatric co-morbidities among young transgender women living with or at risk for HIV infection contribute to health outcomes along the HIV care continuum for this extremely high-risk population.

The goal of this mixed-methods project is to characterize psychiatric symptoms among young transgender women living with and at high risk for HIV infection, and to understand how gender identity and psychiatric co-morbidities impact engagement in care across the HIV care continuum including testing, prevention services, linkage to care, retention, medication adherence, and viral suppression.

Participants will be young transgender women who are either HIV+ or at risk for infection. First, individuals will complete a computer-assisted patient survey that gathers demographic information, measures for mental health, sexual health behavior, medication adherence, and items about access to gender-affirming medical therapies.

Second, a semi-structured interview will be conducted to gain a better understanding of how gender identity and any related mental health symptoms may play a role in engagement in care across the HIV care continuum.

Finally, participants of unknown or negative HIV status will be given the option to take a rapid HIV test after completing their survey and interview. In the event of a positive result, the participant will be connected immediately to HIV resources and care. For those participants who are HIV+, chart review will also be completed to determine rates of retention in care and viral suppression. Chart review is a review of an individual’s medical chart to abstract information pertinent to the research project such as HIV blood test results (e.g. CD4 count and percent, viral load).

Identifying barriers and facilitators to care for young transgender women will inform intervention development and policy change to improve medical and mental health care for this marginalized population along the HIV care continuum. 

Suggested Citation

The Children's Hospital of Philadelphia, PolicyLab. Healthy Bodies, Healthy Minds: Improving Medical and Mental Health Outcomes across the HIV Care Continuum for Young Transgender Women [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].