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PLoS One. 2018 May 22;13(5):e0197730. doi: 10.1371/journal.pone.0197730. eCollection 2018.

Risk behaviors and HIV care continuum outcomes among criminal justice-involved HIV-infected transgender women and cisgender men: Data from the Seek, Test, Treat, and Retain Harmonization Initiative.

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Department of Medicine, Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, United State of America.
Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, D.C., United States of America.
Department of Medicine, University of Washington, Seattle, WA, United States of America.
Department of Social Medicine, Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States of America.
Department of Medicine, Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America.
Department of Internal Medicine, Section of Infectious Disease, Yale University, New Haven, CT, United States of America.
Yale School of Medicine (Yale AIDS Program), Yale University, New Haven, CT, United States of America.
ICAP, Columbia University, New York, NY, United States of America.
Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, United States of America.
RTI International, San Francisco, CA, United States of America.
National Institutes of Health, Bethesda, MD, United States of America.
Department of Biostatistics, University of Washington, Seattle, WA, United States of America.
Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America.
University of Illinois at Chicago, Chicago, IL, United States of America.



Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system.


To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5.


Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p<0.001); both TW and CM reported high rates of condomless sex (58%, 64%, respectively); TW were more likely than CM to have more than one sexual partner (OR = 2.9, 95% CI: 1.6, 5.2; p<0.001) and have engaged in exchange sex (OR = 3.9, 95% CI: 2.3, 6.6; p<0.001). There were no significant differences between TW and CM in the percentage currently taking ART (52%, 49%, respectively), the mean percent adherence to ART (77% for both groups), and the proportion who achieved viral suppression (61%, 58%, respectively).


HIV-infected CJ-involved TW and CM had similar use of ART and viral suppression but TW were more likely than matched CM to engage in exchange sex, have multiple sexual partners, and use crack/cocaine. TW and CM had similarly high rates of condomless sex and use of other drugs. TW require tailored risk reduction interventions, however both CJ-involved TW and CM require focused attention to reduce HIV risk and improve HIV continuum of care outcomes.

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