Methods: Retrospective data were collected from clinic charts of trans women aged 16+ across six family medicine and/or HIV clinics in Montreal and Toronto, Canada from 2018-2019. The prevalence of HIV was reported overall and then compared across sociodemographic, and clinical subgroups followed by univariate and multivariable logistic regression.
Results: Among 1059 patients, 7.5% were living with HIV, 54.4% were HIV negative, and 38.1% were missing HIV status data. Multivariable logistic regression analyses showed higher odds of being 50+ vs. <30 (aOR: 2.52, 95% CI: 1.10, 5.81), Black race vs. white (aOR: 4.35, 95% CI: 1.41, 13.43), landed immigrant/permanent resident status vs. Canadian citizen (aOR: 5.76, 95% CI: 1.54, 21.42), receiving social assistance vs. not (aOR: 4.63, 95% CI: 1.43, 14.93), ever recreational drug use vs. never (aOR: 3.95, 95% 1.19, 13.06), and a history of hepatitis B vs. no history) (aOR: 4.44, 95% CI: 1.12, 16.75), among trans women living with HIV.
Conclusions: The prevalence of HIV in this cohort of trans women in clinical care was lower than expected based on global estimates while also high at 7.5%. That over one-third of patients did not have a documented HIV status suggests gaps in HIV testing. These findings also highlight socioeconomic, psychosocial, and medical challenges among trans women that may be associated with HIV diagnosis and/or suggest impacts on trans women's lives post HIV-diagnosis. These findings can be used to inform the development of HIV prevention and support programs that facilitate engagement and care of trans women experiencing intersecting challenges.