Transgender women (transwomen) experience innumerable challenges and disparities fixed in social inequities. Transwomen are people who identify as female, but were assigned the sex of male at birth. The high prevalence of HIV among transwomen is further complicated by transwomen’s low engagement to HIV care. The purpose of this dissertation is to examine clinical and social factors associated with HIV care among transwomen living with HIV. Guiding this dissertation is the intersectionality framework, which employs a multidimensional view of the various roles that transwomen embody. Three studies are presented in this dissertation. A literature review explored past studies in which stigma, discrimination or transphobia impacts a transwomen’s decision to engage in or not engage in HIV care. The remaining studies utilize secondary data that recruited 318 transwomen in San Francisco using respondent driven sampling. A subset of 123 transwomen was included in two original studies. One study is exploratory and included variables informed by the literature review. This study analyzes factors that were associated with the transwomen in San Francisco that did not access HIV care, was not currently on antiretroviral therapy (ART) and was not virally suppressed or had an unknown viral load. The final study looked at the role of cross-sex hormone therapy (HRT) among transwomen living with HIV and for any associations with transwomen’s HRT. The literature review found 9 studies that transwomen’s HIV care continuum—a sequential step-by step treatment model—was affected by stigmatization and discrimination at every step. The second study found that the experience of multiple discrimination (gender and race) was associated with detectable or unknown viral load. Hormone use was found to be associated with not being on ART. Unstable housing was associated with detectable viral load. The third study found that transwomen living with HIV who stated that their gender identity was validated by relationships had lower odds of not using HRT. Modifying the HIV care continuum to include treatment of the social and economic challenges as well as inclusion of trans-specific health care may positively impact the engagement of transwomen in their HIV care continuum.

A recent study has shown a statistically significant increase in the incidence of Asian Pacific Islanders (API) diagnosed with HIV/AIDS (Adih, Campsmith, Williams, Hardnett, & Hughes, 2011). Although the national prevalence of HIV/AIDS among API is lower than that among other groups, the expected increase of HIV/AIDS in the API population--18 million in 2012 to 40 million by the year 2050--signifies a public health risk. The dearth of studies on API living with HIV/AIDS (API¬-LWHA) and health literacy represents a collective knowledge gap that impinges on prevention strategies, research efforts, policy development, and the lives of API-LWHA. The purpose of this qualitative descriptive study is to explore how API-LWHA seek information regarding their illness. Individual 1-hour interviews were conducted with API-LWHA who were recruited from the Asian and Pacific Islander Wellness Center (APIWC) in San Francisco. The interviews provided a forum for exploring sources, types of information, and participant self-evaluation of the process used to seek information. Eight participants self-identified as API-LWHA completed the interview. Thematic analysis was applied to identify emerging themes. Professional health care workers, social networks, and media (i.e., Internet and printed media) were the primary sources of information. The types of information participants sought, included general HIV topics, HIV medications, and the use of condoms and clean needles--among other topics. Although the sample size is small and recruitment came from a single community-based organization (CBO), the study's findings reveal ways that API-LWHA seek information. This study adds to the body of literature regarding ways that health care providers can enrich their contact with this population through health care, education, research, and policy development. Further studies must be done in order to expand the literature on health literacy and API-LWHA and therefore gain a deeper understanding of the ways API-LWHA explores information regarding their illness.

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