Grant: CIHR Fellowship

Globally, transgender (trans) women experience disproportionately high rates of HIV compared to cisgender (cis) adults, yet lower access to HIV care along the care cascade, falling below national and global guidelines. Little is known regarding underlying mechanisms for why women may be lost between stages of HIV care engagement (e.g., between diagnosis an linkage to care; between linkage to care and ART initiation) and how stigma based on different facets of trans women's identities/experiences (e.g., HIV stigma, transphobia) influence trans women's relationships with their providers. This information is necessary to inform evidence-based, culturally-adapted, multi-level interventions to improve care access for trans women living with HIV. Drawing on data from the Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment (SHAWNA) project, a community-based research project led by the Gender and Sexual Health Initiative and the University of British Columbia and the Trans, Two-Spirit, Gender Diverse (T2SGD) Health Project the proposed research seeks to: 1) understand temporal trends of healthcare access and causal mechanisms for attrition across the care cascade for trans WLWH; 2) explore intersectional stigma in the context of patient-provider relationships; and, 3) develop, implement, and evaluate an intervention to address multi-level barriers to access to HIV care for trans women using community-based research methods. A multi-faceted approach to knowledge translation will be undertaken, including manuscripts produced for high impact HIV/LGBT journals, presentations at national and international conferences, and lay language reports, policy briefs, and presentations to community partners and community advisory boards. The goal of this research is to improve healthcare access for trans women living with HIV, and, ultimately, to improve health and social outcomes and promote social justice for and with trans women with HIV.