LITE Plus (Biopsychosocial Mechanisms Linking Gender Minority Stress and HIV Comorbidities)

                                          OBJECTIVE

The study includes transgender women living with HIV (TWLHIV) in the Boston, MA and Washington, DC metropolitan areas. The project seeks to evaluate relationships between experiences of institutional stigma, chronic stress, and mental health and cardiovascular disease outcomes. This study plans to enroll 200 Black and Latina TWLHIV with study visits occurring every 6 months for 2 years. We are collecting measures of stigma, perceived stress, CVD risk behaviors (e.g. smoking), mental health, coping, and social support. We are also looking at gender-affirming hormone therapy (GAHT) use, CD4 count, HIV viral load, antiretroviral adherence, medications, and other conditions. Measures of body mass index (BMI), waist-height ratio (WHR), blood pressure (BP), and CVD risk estimates as well as salivary cortisol and blood samples for measures of stress biomarkers, inflammation, and heart health are included. Qualitative in-depth-interviews will be conducted with 20-30 TWLHIV to explore their experiences of stress, mental health, and the role of GAHT in their lives.

WHY IS THIS STUDY IMPORTANT?

In October 2016, the National Institute of Minority Health and Disparities (NIMHD) formally designated gender minorities, including transgender women (TW), as a health disparities population. Research among TW has found up to 56% of Black TW and 16% of Latina TW are living with HIV (TWLHIV). The Ryan White HIV/AIDS Program provides HIV services for more than 5,500 TW (53% Black, 29% Latina); and according to a CDC national estimate, more than 5,700 HIV-infected adults receiving medical care in the U.S. self-identify as TW (45% Black, 30% Latina).

Transgender women living with HIV (TWLHIV) experience widespread stigma and discrimination at the societal, interpersonal, and individual levels. Discrimination and stigma cause excess stress associated with health disparities including poor mental health and cardiovascular disease (CVD). Further, evidence on CVD among transgender adults found that TW face higher risk for CVD than non-transgender adults. Gender affirming hormone therapy (GAHT), including estrogen, is commonly used by TW to align their physical appearance with their gender identity. GAHT has been shown to improve mental health for transgender people and to help engagement with healthcare for TWLHIV who may prioritize this gender-related treatment over HIV care. Cross-sectional data suggest that linking GAHT to HIV care may improve commitment to taking HIV medication and improving health.