Characterizing the HIV Care Continuum and Identifying Barriers and Facilitators to HIV Diagnosis and Viral Suppression among Black Transgender Women in the United States


Leigh A. Bukowski
Cristian J. Chandler
Stephanie Creasy
Derrick D. Matthews
Mackey R. Friedman
Ron Stall


BackgroundAlthough Black transgender women (BTW) experience high prevalence of HIV in the United States, no characterization of the HIV care continuum exists for this population. This study addresses this gap by (1) characterizing the HIV care continuum, and (2) exploring correlates of HIV diagnosis and viral suppression among a community based sample of BTW.

MethodsData came from Promoting Our Worth, Equality, and Resilience (POWER). From 2014 to 2017, POWER recruited BTW who attended Black Pride events in six U.S. cities. Participants completed a behavioral health survey and were offered onsite HIV testing. Simple frequencies were used to characterize the HIV carecontinuum, and multivariable logistic regression analysis was used to identify correlates of HIV diagnosis and viral suppression.

ResultsA total of 422 BTW provided completed data for our analysis, 45.0% of whom were living with HIV. Over half of the HIV-positive BTW (51.4%) reported being undiagnosed at the time of survey, and 24.5% reported viral suppression. Incarceration and a lack of access to medical care were significantly and positively associated with an undiagnosed HIV-positive status in multivariable models. Incarceration, homelessness, polydrug use, physical assault, intimate partner violence, and current hormone use were significantly and negatively associated with viral suppression in multivariable models.

ConclusionDeveloping and implementing interventions that address timely HIV diagnosis may assist in informing the HIV disparity among BTW in the U.S. Interventions should address the fundamental causes of poor health in this population.