Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women

Co-occurring psychosocial conditions are associated with increased HIV acquisition and transmission risk among young transgender women in Lima, Peru

In Peru, transgender women (TW) are highly burdened by the HIV epidemic and stigma-related psychosocial conditions. Yet, a dearth of research has assessed co-occurring psychosocial conditions and HIV vulnerability among young TW. From February-July 2022, a community-recruited sample of young TW ages 16-24 years (N = 211) completed a cross-sectional socio-behavioral survey and HIV testing in Lima. Poisson regression models with robust variance estimated the association of indexes of co-occurring psychosocial conditions-childhood (family rejection, bullying, adverse childhood experiences, childhood sexual abuse), violence (psychological, physical, sexual, police violence), mental health (psychological distress, posttraumatic stress disorder, alcohol use disorder, non-injection drug use), and all (range = 0-12)-with past 6-month anal or vaginal condomless sex. Median age was 23 years, the majority were ethno-racial minority (35.1% Indigenous, 34.1% Mestiza, 12.3% Afro-Peruvian), 50.7% reported past 30-day sex work, 33.6% were HIV seropositive, and 42.0% reported past 6-month condomless sex. In separate multivariable sociodemographic-adjusted models, each index was associated with elevated prevalence of past 6-month condomless sex (all p < 0.05). For the overall index, each psychosocial condition increased the prevalence of past 6-month condomless sex by 16% (range = 8-23%). Understanding and intervening on co-occurring psychosocial conditions will be vital to mitigate HIV vulnerability among young TW in this context.

Neighborhood Safety and Neighborhood Police Violence Are Associated with Psychological Distress among English- and Spanish-Speaking Transgender Women of Color in New York City: Finding from the TURNNT Cohort Study

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

BACKGROUND

Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades.

METHODS

Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher's exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades.

RESULTS

Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049).

CONCLUSIONS

We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women.

TRIAL REGISTRATION

NCT, NCT 21-34,978. Registered January 19, 2022.