Unstable Housing Associated With Health Outcomes of Transwomen of Color With HIV

Investigators examine structural factors associated with poor health outcomes among transwomen of color with HIV in the San Francisco Bay Area.

Transwomen of color are 49 times more likely to acquire HIV than the general populace and face numerous barriers—including residential transience, high rates of food insecurity, extreme low income, and high rates of engagement in illicit activities such as sex work for income—which contribute to poor health outcomes, according to a study published in AIDS Care.

Data analyzed in this study were collected from 3 San Francisco area sites within the Special Projects of National Significance program, “Enhancing Engagement in Retention and Quality of Care for Transgender Women of Color Initiative.”  The final study sample was 159 transwomen of color living with HIV, with an average age of 39.4 years. Approximately one-third (n=55, 34.6%) of participants did not finish high school or get their General Equivalency Diploma, but 36.5% (n=58) did. The remaining 27.7% (n=44) attended at least some college education. Most study participants earned less than $35,999 a year (81.1%), and 93.1% had health insurance, with 71.7% being public insurance.

Residential transience was common among participants (20.1%, n=32), with nearly half reporting unstable housing in the last 6 months (n=70, 44.0%), and nearly half reporting living in a shelter, rooming house, transitional housing, hotel, or being homeless in the last 6 months (n=77, 48.4%). Most of the participants experienced food insecurity in the last 6 months (n=89, 56.0%), and 46.5% (n=74) reported participating in sex work in the last 6 months. Participants who engaged in sex work or other illicit sources of income were significantly less likely to receive primary care for HIV compared with those who did not.

Study investigators conclude, “our study points to the needs for structural interventions that go beyond medical and trans-specific health care to meet the needs of [transwomen of color] living with HIV. And as evidence mounts, we must find ways to leverage our public health, policy and research to demand better quality of life circumstances for this community in order to ensure their health and wellness.” 

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Wilson EC, Turner C, Arayasirikul S, et al. Housing and income effects on HIV-related health outcomes in the San Francisco Bay Area – findings from the SPNS transwomen of color initiative [published online June 19, 2018]. AIDS Care. doi: 10.1080/09540121.2018.1489102