Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women

English version

Autoři: Arjee J. Restar ^aff001; E. Karina Santamaria ^aff001; Alexander Adia ^aff001; Jennifer Nazareno ^aff001; Randolph Chan ^aff004; Mark Lurie ^aff001; Theo Sandfort ^aff005; Laufred Hernandez ^aff006; Susan Cu-Uvin ^aff001; Don Operario ^aff001
Působiště autorů: Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America ^aff001; The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America ^aff002; amfAR, The Foundation of AIDS Research, Washington, DC, United States of America ^aff003; Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong ^aff004; HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division on Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America ^aff005; Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines ^aff006; Providence-Boston Center for AIDS Research, Providence, RI, United States of America ^aff007; Miriam Hospital, Department of Medicine, Providence, RI, United States of America ^aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224133

Souhrn

Background

Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration.

Methods

We conducted semi-structured interviews with trans women (n = 9) who self-reported as HIV-positive and their HIV providers (n = 15) from community-based venues (e.g., clinics) in Manila, Philippines.

Results

We identified five key themes from our qualitative data: (1) provider’s concerns; (2) patient’s goals; (3) affirmative vs. non-affirmative provider rhetoric; (4) alignment vs. misalignment of provider rhetoric to patient goals; and (5) FHT and ART-related decisions. Based on these themes, we describe a gender-affirmative HIV care framework to understand FHT-ART decisions among trans women living with HIV. Based on our data, this framework shows that provider-patient communications regarding ART and FHT consists primarily of provider concerns and patient goals regarding FHT. These communications can take on a gender-affirmative or non-affirmative style of rhetoric that either aligns or misaligns with patient goals and may lead to differences in FHT and ART-related decisions among trans women living with HIV.

Conclusion

There exist mixed regimens and beliefs about taking FHT and ART among this sample of trans women. While trans participants’ main source of health information is their HIV provider, providers are likely to communicate non-affirmative rhetoric that negatively impacts trans women’s decision to take FHT and ART. Research is needed to elucidate co-prescriptions of gender-affirmative services with HIV care among this group in the Philippines.

Klíčová slova:

Women's health – Health care providers – Mental health and psychiatry – Health care policy – HIV epidemiology – Philippines

Zdroje

1. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2013;13(3):214–22. doi: 10.1016/S1473-3099(12)70315-8 23260128

2. Philippines Department of Health. HIV/AIDS and ART registry of the Philippines (HARP) report–October 2017: Manila, Philippines: Department of Health; 2017 [Available from: http://www.doh.gov.ph/sites/default/files/statistics/EB_HIV_Oct_AIDSreg2017.pdf.

3. World Health Organization. Transgender people and HIV. Retrieved from https://www.who.int/hiv/pub/transgender/transgender-hiv-policy/en/. 2015.

4. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2017 2017 [Available from: http://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf.

5. United Nations Development Programme [UNDP]. Missing in Action–Loss of clients from HIV testing, treatment, care and support services: Case studies of gay men and other men who have sex with men in Manila. Bangkok 2017 [Available from: http://www.ph.undp.org/content/philippines/en/home/library/hiv_aids/MissingInAction.html.

6. Philippines Department of Health. HIV/AIDS and ART registry of the Philippines (HARP) report–December 2018: Manila, Philippines: Department of Health; 2018 [Available from: https://www.aidsdatahub.org/sites/default/files/publication/EB_HIV_December_AIDSreg2018.pdf.

7. Asuncion I, Segarra A, Samonte G, N. P, Bermejo M. The state of the Philippine HIV epidemic 2016: Facing challenges, forging solutions: Manila, Philippines: Department of Health; 2017 [Available from: http://www.doh.gov.ph/sites/default/files/publications/publication__nonSerials_State%20of%20HIV%20Epidemic%20in%20the%20Philippines.pdf.

8. World Health Organization [WHO]. Country profiles on HIV: Philippines 2016 [Available from: http://www.wpro.who.int/hiv/data/countries/phl/en/.

9. Philippines Department of Health. HIV/AIDS and ART registry of the Philippines (HARP) report–June 2016: Manila, Philippines: Department of Health; 2016 [Available from: http://www.aidsdatahub.org/sites/default/files/publication/NEC_HIV_Jun-AIDSreg2016.pdf.

10. Philippines Department of Health. 2015 Integrated HIV behavioral and serologic surveillance (IHBSS): Philippines: Manila, Philippines: Department of Health; 2017 [

11. Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, et al. Lifetime risk factors for HIV/STI infections among male-to-female transgender persons. Journal of Acquired Immune Deficiency Syndromes. 2009;52(3):417. doi: 10.1097/QAI.0b013e3181ab6ed8 19550351

12. Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. Journal of Acquired Immune Deficiency Syndromes. 2016;72(Suppl 3):S235.

13. Sevelius JM. Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11–12):675–89. doi: 10.1007/s11199-012-0216-5 23729971

14. Sevelius JM, Saberi P, Johnson MO. Correlates of antiretroviral adherence and viral load among transgender women living with HIV. AIDS care. 2014;26(8):976–82. doi: 10.1080/09540121.2014.896451 24646419

15. Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. Journal of the Association of Nurses in AIDS Care. 2010;21(3):256–64. doi: 10.1016/j.jana.2010.01.005 20347342

16. Joint United Nations Programme on HIV/AIDS. 90-90-90: An Ambitious Treatment Target To Help End the AIDS Epidemic. Geneva: UNAIDS. 2014.

17. Fontanaria AMV, Zanellab GI, Feijób M, Churchillc S, Lobatoa MIsR, Costab AB. HIV-related care for transgender people: A systematic review of studies from around the world. Social Science and Medicine. 2019;230:280–94. doi: 10.1016/j.socscimed.2019.03.016 31035207

18. Reisner SL, Perez-Brumer AG, McLean SA, Lama JR, Silva-Santisteban A, Huerta L, et al. Perceived barriers and facilitators to integrating HIV prevention and treatment with cross-sex hormone therapy for transgender women in Lima, Peru. AIDS and Behavior. 2017;21(12):3299–311. doi: 10.1007/s10461-017-1768-8 28421354

19. Dowshen N, Lee S, Franklin J, Castillo M, Barg F. Access to medical and mental health services across the HIV care continuum among young transgender women: a qualitative study. Transgender Health. 2017;2(1):81–90. doi: 10.1089/trgh.2016.0046 28861551

20. Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Annals of Behavioral Medicine. 2013;47(1):5–16.

21. Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: The critical role of gender affirmation in research and clinical practices. Journal of the International AIDS Society. 2016;19(7S6).

22. Reisner SL, Bradford J, Hopwood R, Gonzalez A, Makadon H, Todisco D, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. Journal of Urban Health. 2015;92(3):584–92. doi: 10.1007/s11524-015-9947-2 25779756

23. Jin H, Restar A, Biello K, Kuhns L, Reisner S, Garofalo R, et al. Burden of HIV among young transgender women: factors associated with HIV infection and HIV treatment engagement. AIDS Care. 2019;31(1):125–30. doi: 10.1080/09540121.2018.1539213 30380926

24. Restar A, Nguyen M, Nguyen K, Adia A, Nazareno J, Yoshioka E, et al. Trends and emerging directions in HIV risk and prevention research in the Philippines: A systematic review of the literature. PLOS One. 2018;13(12):e0207663. doi: 10.1371/journal.pone.0207663 30517178

25. World Health Organization [WHO]. External review of the national health sector response to HIV and sexually transmitted infections 2013: Republic of the Philippines 2015 [Available from: http://iris.wpro.who.int/bitstream/handle/10665.1/11217/9789290617068_eng.pdf.

26. Radix A, Sevelius J, Deutsch MB. Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices. Journal of the International AIDS Society. 2016;19:20810. doi: 10.7448/IAS.19.3.20810 27431475

27. Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Global Public Health. 2016;11(7–8):1060–75. doi: 10.1080/17441692.2016.1154085 26963756

28. Rich KM, Wickersham JA, Valencia Huamaní J, Kiani SN, Cabello R, Elish P, et al. Factors Associated with HIV Viral Suppression Among Transgender Women in Lima, Peru. LGBT Health. 2018;5(8):477–83. doi: 10.1089/lgbt.2017.0186 30874476

29. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007;19(6):349–57. doi: 10.1093/intqhc/mzm042 17872937

30. Brentano F. Psychology from an empirical standpoint: Routledge; 2012.

31. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity. 2018;52(4):1893–907.

32. Biernacki P, Waldorf D. Snowball sampling: Problems and techniques of chain referral sampling. Sociological Methods Research. 1981;10(2):141–63.

33. Gonzalez A. The language planning situation in the Philippines. Journal of Multilingual and Multicultural Development. 1998;19(5):487–525.

34. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.

35. Dedoose. Web application for managing, analyzing, and presenting qualitative and mixed method research data. 2015.

36. Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Services Research. 1999;34(5 Pt 2):1189. 10591279

37. Thomas DD, Safer JD. A simple intervention raised resident-physician willingness to assist transgender patients seeking hormone therapy. Endocrine Practice. 2015;21(10):1134–42. doi: 10.4158/EP15777.OR 26151424

38. Stieglitz KA. Development, risk, and resilience of transgender youth. Journal of the Association of Nurses in AIDS Care. 2010;21(3):192–206. doi: 10.1016/j.jana.2009.08.004 20347346

39. Poteat T, German D, Kerrigan D. Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science and Medicine. 2013;84:22–9. doi: 10.1016/j.socscimed.2013.02.019 23517700

40. Vance SR Jr, Halpern-Felsher BL, Rosenthal SM. Health care providers' comfort with and barriers to care of transgender youth. Journal of Adolescent Health. 2015;56(2):251–3. doi: 10.1016/j.jadohealth.2014.11.002 25620310

41. Tawasil JR, Salvador VD, Juban NR, Chan MB. HIV/AIDS Education in Health Professionals Training in the Philippines. Washington, DC: World Bank. 2012.

42. Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. Journal of Adolescent Health. 2015;56(3):274–9. doi: 10.1016/j.jadohealth.2014.10.264 25577670

43. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine. 2000;160(14):2101–7. doi: 10.1001/archinte.160.14.2101 10904452

44. Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. The Lancet. 2016;388(10042):401–11.

45. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. Journal of Family Practice. 2000;49(9):796–. 11032203

46. Ogden J, Esim S, Grown C. Expanding the care continuum for HIV/AIDS: bringing carers into focus. Health Policy Planning. 2006;21(5):333–42. doi: 10.1093/heapol/czl025 16940299

47. Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases. 2011;52(6):793–800. doi: 10.1093/cid/ciq243 21367734

48. Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I don't think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care. 2009;20(5):348–61. doi: 10.1016/j.jana.2009.07.004 19732694

49. Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Quality of Life Research. 2006;15(9):1447–57. doi: 10.1007/s11136-006-0002-3 16758113

50. Strauss JS. Hormones in cosmetics. JAMA. 1963;186(8):759–62.

51. Dubov A, Fraenkel L. Facial feminization surgery: The ethics of gatekeeping in transgender health. The American Journal of Bioethics. 2018;18(12):3–9. doi: 10.1080/15265161.2018.1531159 31159688

52. Altman K. Facial feminization surgery: current state of the art. International Journal of Oral Maxillofacial Surgery. 2012;41(8):885–94. doi: 10.1016/j.ijom.2012.04.024 22682235

53. Grossman AH, D'augelli AR. Transgender youth: Invisible and vulnerable. Journal of Homosexuality. 2006;51(1):111–28. doi: 10.1300/J082v51n01_06 16893828

54. Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. American Journal of Public Health. 2013;103(10):1820–9. doi: 10.2105/AJPH.2012.300796 23153142

55. Carmel TC, Erickson-Schroth L. Mental health and the transgender population. Psychiatric Annals. 2016;46(6):346–9.

56. Lombardi EL, van Servellen G. Building culturally sensitive substance use prevention and treatment programs for transgendered populations. Journal of Substance Abuse Treatment. 2000;19(3):291–6. 11027900

57. da Silva DC, Schwarz K, Fontanari AMV, Costa AB, Massuda R, Henriques AA, et al. WHOQOL-100 before and after sex reassignment surgery in Brazilian male-to-female transsexual individuals. The Journal of Sexual Medicine. 2016;13(6):988–93. doi: 10.1016/j.jsxm.2016.03.370 27117529

58. Bauer GR, Scheim AI, Pyne J, Travers R, Hammond R. Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health. 2015;15(1):525.

59. White Hughto JM, Reisner SL. A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals. Transgender Health. 2016;1(1):21–31. doi: 10.1089/trgh.2015.0008 27595141

60. Edwards AL. The social desirability variable in personality assessment and research. Ft Worth, TX, US: Dryden Press. 1957.

61. Richman WL, Kiesler S, Weisband S, Drasgow F. A meta-analytic study of social desirability distortion in computer-administered questionnaires, traditional questionnaires, and interviews. Journal of Applied Psychology. 1999;84(5):754.

62. Day HR, editor Interrelationships of Machiavellianism, social desirability, self-evaluation, and self-potency in American and Filipino samples: With a Philippines replication. Proceedings of the Annual Convention of the American Psychological Association; 1972: American Psychological Association.