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AIDS Behav. 2019 May 29. doi: 10.1007/s10461-019-02544-2. [Epub ahead of print]

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV.

Author information

1
Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA. jae.sevelius@ucsf.edu.
2
Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA. jae.sevelius@ucsf.edu.
3
Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA.
4
Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA.
5
Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA.
6
Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, CA, USA.

Abstract

Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.

KEYWORDS:

Gender affirmation; HIV; Healthcare empowerment; Transgender; Viral suppression

PMID:
31144131
DOI:
10.1007/s10461-019-02544-2

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