Experiences of trans women living with HIV in Canada: findings from a national community-based participatory research project

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1 Experiences of trans women living with HIV in Canada: findings from a national community-based participatory research project Yasmeen Persad, Ashley Lacombe-Duncan, Nadia O Brien, Greta R. Bauer, Nora Butler-Burke, Kerrigan Beaver, Val Nicholson, Carmen H. Logie, Alexandra de Pokomandy, Angela Kaida, & Mona Loutfy, on behalf of the CHIWOS Research Team OHTN Conference, ENDGAME II: Stopping the Syndemics that Drive HIV November 21 st, 2016

2 Presenter Disclosure Presenter: Yasmeen Persad I have no relationships with commercial interests to disclose.

3 Acknowledgements We wish to acknowledge this land on which this conference is being held. For thousands of years it has been the traditional land of the Huron-Wendat, the Seneca, and most recently, the Mississaugas of the Credit River. Today, this meeting place is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land.

4 Acknowledgements This presentation is based on the Canadian HIV Women s Sexual and Reproductive Health Cohort (CHIWOS) A big thank you to all the CHIWOS participants Thank you to the CHIWOS co-pis, provincial co-ordinators, PRAs, and the entire national core research team, Steering Committee members, CAB members, CACBAB members, CAAB-PAW members, and all the coinvestigators, collaborators, working group members, and community partners committed to this study! Thank you to our affiliated studies: REACH and CANOC Thank you to our funders: CIHR (Institute of Gender and Health) and the CTN

5 Acknowledgements We honour and remember the CHIWOS participants and peer research associates who have passed away and are no longer with us.

6 In Memoriam of Marisol Desbiens, dear friend and colleague (ON PRA)

7 Syndemics, trans women, and HIV Community activists, clinicians, and academics have long recognized that multiple, cooccurring social and health disparities affect the health of trans people.

8 Intersectionality and Trans Women with HIV Multiple types of stigma shape the experiences of trans women with HIV. Lacombe-Duncan, A. (2016). An intersectional perspective on access to HIV-related healthcare for transgender women. Transgender Health, 1. doi: /trgh

9 Social determinants of health: A trans cultural perspective Social factors have key implications on health Simply administering medical treatment is often insufficient to improve health Poverty, gender inequity, and a multitude of other factors have a major impact on women s vulnerability to health problems and (in)ability to access care and support Trans women have a much higher risk of HIV due to social and structural issues

10 Gaps in the literature: Experiences of trans women living with HIV Little is known about how these social and structural inequities are experienced by trans women living with HIV, particularly in a Canadian context We conducted a preliminary analysis looking at the social determinants of health for trans women participating in a large cohort of women living with HIV in Canada CPATH: Determinants of Health into 10

11 Study Design Canadian HIV WOmen s Sexual and Reproductive Health Cohort Survey Longitudinal cohort study Multi-centred (ON, QB, BC) Expanding to MB & SK Community-based research Equitable involvement of those affected by the research in the research Shared decision making processes Focus on action and change

12 Full sample Current Study Provinces Future Study Provinces National Total= 1425 Participants British Columbia 356 (25%) Ontario 713 (50%) Quebec 356 (25%)

13 Methods in this analysis Study Objectives: Compare cis and trans women in CHIWOS across sociodemographic factors (age, race/ethnicity, sexual orientation, education), key social determinants of health (income, employment, housing and food security, social exclusion, and access to HIVrelated), and health and mental health outcomes (CD4 count, viral load, depression, PTSD).

14 Methods in this analysis Descriptive statistics (means, SD; frequencies) Compared factors between cis (n=1360) and trans (n=53) women participating in CHIWOS using chi-square and ANOVA Transgender (trans) women: people labeled male at birth who identify as girls or women or trans women, sometimes referred to as people on the male-tofemale or transfeminine spectrum Cisgender (cis) women: refers to people labeled female at birth who identify as girls or women 14

15 Socio-demographic characteristics of trans women in CHIWOS (n = 53) Mean age: 41.2 years (SD: 10.3) 56.9% identify as heterosexual 82.7% have a high school or higher education 79.2% are single/separated/widowed/divorced 35.8% of women are Indigenous, and 35.8% White/Caucasian, 20.8% Other ethnicity, 7.5% Black* 71.7% were born in Canada 73.1% living with HIV for 6 + years

16 Ethno-racial differences, cis (n=1260) and trans (n=53) women living with HIV p<0.001

17

18 Access to the SDOH for trans women with HIV: Income Most trans women are living in the lowest income bracket, below the poverty line p< 0.001

19 Access to the SDOH for trans women with HIV: Main sources of income Social assistance/ei/pension/wcbi 77.4% *a smaller proportion of trans women have paid employment compared to cis women (11.3% vs 22.7%) *a larger proportion of trans women report sex work as a source of income compared to cis women (9.4% vs 1.7%) < 0.05

20 Housing Stability and Food Security Characteristic Trans women (n=53) Cis women (n=1260) P-value Stable Housing n (%) Unstable Housing n (%) 39 (73.6%) 14 (26.4%) 1224 (90.0%) 136 (10.0%) Food Insecure n (%) Food Secure n (%) 19 (64.2) 34 (35.8) 865 (63.9) 488 (36.1) Photo:

21 Social exclusion 87.8% of trans women experienced violence in childhood (vs 68.0% of cis women) (p<0.01) Among trans women specifically 84.1% report sometimes/many times being made fun of or called names for their trans identity or experience 88.6% report sometimes/many times hearing that trans people are not normal 81.8% report sometimes or many times being fetishized sexually because they are trans

22 Access to the SDOH for trans women with HIV: Access to HIV Healthcare p< % of trans women have never accessed HIV-related care vs 2.5% of cis women (p<.05) Ever used ART Never used ART

23 Access to the SDOH for trans women with HIV: Trans-specific and general healthcare 68.1% of women currently taking hormones 38.3% of women report that their HIV doctor has not discussed potential interactions between hormones and HIV medication 55.3% of women have a family doctor other than HIV doctor Most women report being comfortable or very comfortable discussing trans-specific healthcare needs with their family doctor (92.3%) and HIV doctor (86.5%)

24 Number of women receiving other support services onsite of HIV clinic 15 th Philadelphia Trans Health Conference

25 Health characteristics of trans women in CHIWOS 67.9% (n=36) currently on ARVs 76.6% self-reported undetectable viral load 32.1% have been diagnosed with Hepatitis C 9.4% have been diagnosed with Hepatitis B 15 th Philadelphia Trans Health Conference

26 CD4 Count differences p< Less than 500 cells/mm3 More than 500 cells/mm3 Trans women Cis women

27 Mental health characteristics of trans women in CHIWOS 44.2% have clinical depression (CES-D) 44.2% have PTSD

28 Recreational drug use: Previous, current, never Not currently, but previously used recreational drugs p<0.001 Currently use recreational drugs Never used recreational drugs Trans women report a higher mean hazardous alcohol use score compared to cis women (F(1,1344)=4.431, p<0.05) Trans women Cis women

29 No significant differences in Social support score Resilience score Total HIV stigma or social support, personalized, disclosure, negative self-image, or public attitude subscales Violence as an adult ART adherence Overall physical health (SF-12) Overall mental health (SF-12) Injection drug use Smoking Cannabis use

30 Key Takeaways from the Data Trans women with HIV Are predominantly living in poverty Experience very high rates of violence in childhood and adulthood Experience social isolation and transphobia Experience less access to HIV-related care compared to cis women with HIV Have a need to access many different types of services trans-specific, mental health, substance use, SDOH (income/employment), in addition to HIV care 30

31 Recommendations Knowledge transfer among HCPs E.g. Trans training in the workplace Include trans people in developing educational and training materials specific to HIV Empower and involve trans people to shape welcoming, safe and inclusive health care provision Trans inclusion in all levels of trans health care decisions Providers need to think about think about the social determinants of health when providing healthcare for trans women with HIV CPATH: Determinants of Health into 31

32 Thank you for your attention! Contact us Yasmeen Persad, ON Coordinator: Logan Kennedy Visit our website: on Twitter

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