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，在美国有超过100万人感染人类免疫缺陷病毒（HIV），每年约有56300例新感染病例。变性妇女（即以女性身份生活的生理男性）感染艾滋病毒以及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，TGW在所有性别和性少数群体中艾滋病毒感染率最高。然而，研究还表明，她们进入艾滋病毒治疗并继续接受治疗的可能性较小。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，与其他性少数群体（如男男性行为者和双性恋男性）相比，TGW进入艾滋病毒护理的可能性也更小。历史上，对性别和性少数群体的研究将跨性别人群包括在女同性恋、男同性恋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，这种综合方法掩盖了这些人群内部和之间存在的差异，导致对跨性别人群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的艾滋病毒卫生保健利用的经验（寻求，进入，或保留在护理）。具体来说，它将研究社会网络因素在TGW决定进入和继续从事护理的作用，并描述在整个疾病过程中支持他们使用艾滋病毒护理的社会动态（过程）。鉴于对这一人群的研究缺乏，我们将采用一种扎根的理论方法来探索社会网络规范如何影响TGW关于何时、何地、如何以及是否寻求艾滋病毒护理的决定，以及他们进入、进展和保留护理的模式和途径。艾滋病毒/艾滋病是性别和性少数群体，特别是同性恋妇女面临的最严重的公共卫生危机之一。本研究的结果将有助于更好地了解决定HIV诊断后TGW的HIV卫生保健利用行为（进入和保留护理）的社会因素。此外，这项研究将通过扩大对医疗保健不平等和针对变性人的保健需求这两个医学研究所概述的优先领域的认识，对变性人健康科学的现状作出贡献。本研究结果将为建立性别和性少数群体健康研究项目提供坚实的基础。重要的是，研究结果还将用于教育保健专业人员了解受艾滋病毒感染的老龄妇女的需求，并为制定战略提供信息，以促进这一人群对艾滋病毒的保健利用。

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.