Violence and viral suppression among gender diverse people

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PROJECT SUMMARY/ABSTRACT There is increasing evidence that transfeminine individuals (TF) experience dual epidemics of HIV and intimate partner violence (IPV), yet understanding of the synergies between these two epidemics is underdeveloped. Transfeminine individuals continue to be of the the risk groups most severely affected by HIV in the United States. In parallel, estimated prevalence for receipt of IPV among TF range from 12% to 62%. Emergent evidence demonstrates associations between the experience of IPV among TF and the risk of HIV acquisition or participation in risk behaviors that heighten the risk of HIV (i.e. substance use), but the relationship between the experience of IPV for TF living with HIV and HIV clinical care is less understood. The overwhelming majority of evidence linking IPV and sub-optimal HIV care comes from studies of heterosexual women. A recent meta- analysis showed that women's experience of IPV was associated with 55% lower odds of self-reported adherence and 36% decreased odds of viral suppression. Studies that have looked at associations between clinical care and IPV for sexual and gender minority groups living with HIV have all been hampered by methodological limitations: cross-sectional study designs with clinic-based populations that limit the ability to draw conclusions as to how IPV affects engagement in HIV care for partnered TF living with HIV. We propose an innovative 6- month cohort study of HIV-positive TF – as a supplement to an existing cohort study of HIV positive men who have sex with men - to identify the pathways and points of intervention between IPV and HIV care for US TF. The proposed research activities include a prospective 6-month cohort of 100 HIV-positive partnered TF (>18 years) recruited online from across the US. The cohort study will employ a measure of IPV developed specifically to capture IPV as experienced by TF, and will consider the experience of IPV (victimization, perpetration and bidirectional IPV), and severity and frequency of IPV as drivers of engagement in HIV care. Biomarkers of viral load will be collected from all participants. The overall aim of the proposed activities is to provide new knowledge of how victimization or perpetration of IPV shapes engagement in HIV care and is associated with the ability to achieve and maintain viral suppression.