Social Patterns and Pathways of HIV Care among HIV Positive Transgender Women

描述（由申请人提供）：疾病控制和预防中心（CDC）估计，美国有超过一百万人感染人类免疫缺陷病毒（HIV），每年约有56，300例新感染病例。跨性别女性（Transgender Women，TGW），这些妇女（即生理上的男性，以女性身份生活）感染艾滋病毒和与艾滋病毒有关的发病率和死亡率的风险特别高。各种研究表明，在所有性别和性少数群体中，图瓦卢妇女的艾滋病毒感染率最高。然而，研究也表明，他们不太可能进入和留在艾滋病毒护理。因此，他们更有可能遭受不利的健康后果并感染他人。即使他们知道自己感染了艾滋病毒，TGW也不太可能比其他性少数群体，如男男性行为者和双性恋男子，进入艾滋病毒护理。从历史上看，关于性别和性少数群体的研究将跨性别人口包括在女同性恋者、男同性恋者和双性恋者的集体群体中。国家艾滋病政策办公室和医学研究所最近提出的建议警告说，这种综合办法掩盖了这些人口内部和之间存在的差异，导致对变性人口的健康需求和经历的审查不足。本研究旨在解决这些问题，并将探讨TGW的经验，艾滋病毒的卫生保健利用（寻求，进入，或被保留在护理）。具体而言，它将研究的作用，TGW的决定，进入和保持从事护理和描述的社会动态（过程），巩固他们使用的艾滋病毒护理的整个过程中，他们的疾病的社会网络因素。鉴于缺乏与这一人群的研究，扎根理论的方法将被用来探讨社会网络规范如何影响TGW的决定，何时，何地，如何，以及是否寻求艾滋病毒护理，以及模式和途径，通过它们进入，通过进步，并保留在护理。艾滋病毒/艾滋病是性别和性少数群体，特别是TGW面临的最严重的公共卫生危机之一。这项研究的结果将有助于更好地了解社会因素，确定艾滋病毒的卫生保健利用行为（进入和保留在护理）的TGW后，艾滋病毒诊断。此外，这项研究将有助于跨性别健康科学的状态，通过扩大医疗保健不平等和跨性别特定的健康需求，由医学研究所概述的两个优先领域的知识。这项研究的结果将为建立性别和性少数群体健康研究计划提供坚实的基础。重要的是，研究结果还将用于教育卫生保健专业人员了解艾滋病毒感染的TGW的需求，并为制定战略提供信息，以促进这一人群对艾滋病毒卫生保健的利用。 公共卫生相关性：跨性别妇女（生物学上的男性，但自认为是女性）在所有性别和性少数群体中感染艾滋病毒的比率最高，但不太可能感染艾滋病毒。 接受艾滋病护理。社会支持系统中的关系和治疗系统中的医疗保健遭遇会影响个人寻求，进入和继续参与护理的决定。这项研究将提供的信息，将有助于我们了解TGW之间的艾滋病毒护理使用的社会模式和途径，并将有助于发展社会和结构性干预措施，以改善艾滋病毒护理和健康结果的跨性别妇女与艾滋病毒。

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention (CDC) estimate that there are more than one million people living with Human Immunodeficiency Virus (HIV) in the United States and each year there are approximately 56,300 new cases of infection. Transgender women (TGW), (i.e.,biological men who live their lives as women), are at particularly high risk for HIV infection and HIV-related morbidity and mortality. Various studies indicate that TGW have the highest HIV prevalence rates of all gender and sexual minorities. However, research also shows that they are less likely to enter and be retained in HIV care. Consequently, they are more likely to suffer adverse health outcomes and infect others. Even once they know they are HIV-infected, TGW are also less likely than other sexual minorities, such as men who have sex with men and bisexual men, to enter HIV care. Historically, research on gender and sexual minorities has included the transgender population in the collective group of lesbian, gay, and bisexual persons. Recent recommendations by the Office of National AIDS Policy and the Institute of Medicine have cautioned that this combined approach has obscured the differences that exist within and between these populations, and has resulted in inadequate examination of the health needs and experiences of the transgender population. This study aims to address these concerns and will explore TGW's experiences of HIV health care utilization (seeking, entering, or being retained in care). Specifically, it will examine the role of social network factors on TGW's decisions to enter into and remain engaged in care and describe the social dynamics (processes) that undergird their use of HIV care throughout the course of their illness. Given the paucity of research with this population, a grounded theory approach will be used to explore how social network norms influence TGW's decisions about when, where, how, and if to seek HIV care, as well as the patterns and pathways through which they enter, progress through, and are retained in care. HIV/AIDS is one of the most critical public health crises confronting gender and sexual minorities, especially TGW. Findings from this study will facilitate a better understanding of the social factors that determine HIV health care utilization behaviors (entry into and retention in care) of TGW following an HIV diagnosis. In addition, this study will contribute to the state of the science of transgender health by expanding knowledge of health care inequalities and transgender-specific health needs, two priority areas outlined by the Institute of Medicine. Results from this study wil provide a strong foundation for establishing a program of research in gender and sexual minority health. Importantly, the results will also be used to educate health care professionals about the needs of HIV infected TGW and to inform the development of strategies to facilitate HIV health care utilization in this population. PUBLIC HEALTH RELEVANCE: Transgender women (biological men who identify as women) have the highest rates of HIV infection of all gender and sexual minorities, yet are less likely to receive HIV care. Relationships in the social support system and health care encounters within the treatment system influence an individual's decision to seek, enter, and remain engaged in care. This study will provide information that will help us understand the social patterns and pathways of HIV care use among TGW and will contribute to development of social and structural interventions to improve HIV care and health outcomes for transgender women with HIV.