Yasmeen Persad, Research Coordinator, Women's College Hospital, ON, Canada
Mostafa Shokoohi, Postdoctoral Research Fellow, Dalla Lana School of Public Health, University of Toronto, ON, Canada
Angela Underhill, Research Manager, Women's College Hospital, ON, Canada
Nimâ Machouf, Researcher, Clinique de Médecine Urbaine du Quartier Latin
Pierre Côté, Physician and Researcher, Clinique de Médecine Urbaine du Quartier Latin
Megan Wheatley, Research Assistant, Women's College Hospital, ON, Canada
Meenakshi Gupta, Research Assistant, Women's College Hospital, ON, Canada
Luke T. Kyne, Research Assistant, Women's College Hospital, ON, Canada
Amir A. Besharati, Research Assistant, Clinique de Médecine Urbaine du Quartier Latin, QC
L.Y. Louie Chan, Physician and Researcher, Department of Family & Community Medicine, University of Toronto, ON
Sue Hranilovic, Primary Health Care Nurse Practitioner and Researcher, St. Michael’s Hospital, ON
Quang Nguyen, Physician and Researcher, Department of Family & Community Medicine, University of Toronto, ON
Mona Loutfy, MPH, MD, FRCPC, MPH, Professor, Department of Medicine, University of Toronto, ON, Canada
Background and Purpose: Data on HIV prevalence among transgender (trans) people are not routinely collected nor reported in national estimates, including in Canada. This lack of data may contribute to gender-based inequities in the HIV response. Trans women, in particular, experience a disproportionate prevalence of HIV globally, influenced by stigma and discrimination. Thus, our study sought to examine the HIV prevalence and associated factors among trans women engaged in clinical care in the two largest Canadian cities. An overarching goal of this study was to inform the development of targeted interventions to reduce HIV inequities among trans women.
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.
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