Access to healthcare among transgender women living with and without HIV in the United States: associations with gender minority stress and resilience factors.

Jan 22, 2024

Contributors: Talia A Loeb,Sarah M Murray,Erin E Cooney,Tonia Poteat,Keri N Althoff,Christopher M Cannon,Jason S Schneider,Kenneth H Mayer,J Sonya Haw,Andrew J Wawrzyniak,Asa E Radix,Jowanna Malone,Dee Adams,Megan Stevenson,Sari L Reisner,Andrea L Wirtz,

Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States.
This study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status.
Higher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access.
Gender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities.

© 2024. The Author(s).

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ABOUT THE CONTRIBUTORS

Talia A Loeb,Sarah M Murray,Erin E Cooney,Tonia Poteat,Keri N Althoff,Christopher M Cannon,Jason S Schneider,Kenneth H Mayer,J Sonya Haw,Andrew J Wawrzyniak,Asa E Radix,Jowanna Malone,Dee Adams,Megan Stevenson,Sari L Reisner,Andrea L Wirtz,
Talia A Loeb

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA. tloeb2@jh.edu.

Sarah M Murray

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Erin E Cooney

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Tonia Poteat

Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

Keri N Althoff

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.

Christopher M Cannon

Whitman-Walter Institute, Inc., Washington, DC, USA.

Jason S Schneider

Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Kenneth H Mayer

The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA.

Beth Israel Deaconess Medical Center, Boston, MA, USA.

Harvard Medical School, Boston, MA, USA.

J Sonya Haw

Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA.

Andrew J Wawrzyniak

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.

Asa E Radix

Department of Medicine, Callen-Lorde Community Health Center, New York, NY, USA.

Jowanna Malone

Whitman-Walter Institute, Inc., Washington, DC, USA.

Dee Adams

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.

Megan Stevenson

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.

Sari L Reisner

The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA.

Harvard Medical School, Boston, MA, USA.

Brigham and Women’s Hospital, Boston, MA, USA.

Harvard School of Public Health, Boston, MA, USA.

Andrea L Wirtz

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.