Disclosure, comfort, and negative experiences with HIV care providers among transgender women living with HIV in Canada: Findings from a prospective cohort study of women living with HIV in Canada.

BACKGROUND

Transgender (trans) women living with HIV often face barriers to accessing inclusive and comprehensive primary and HIV care.

OBJECTIVES

We aimed to (1) describe differences in trans women's disclosure of their trans identity and comfort discussing trans identity and trans-specific healthcare needs, based on physician type, and (2) report on the prevalence of negative trans-specific experiences with HIV physicians and any provider-related factors associated with comfort.

DESIGN

Data of trans participants in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed across three waves (2013-2018).

METHODS

Descriptive statistics explored disclosure of trans identity and comfort discussing trans-specific healthcare needs with family physicians versus HIV physicians. Fisher's exact tests of association explored the relationship between provider-related factors and self-reported comfort. Prevalence of negative trans-specific experiences with HIV physicians was reported.

RESULTS

At baseline, of 54 trans women, 39 (72.2%) had a physician who supervised their HIV care in the year preceding (HIV physician). Among this subset, 94.9% had disclosed their trans identity and 82.1% reported feeling comfortable discussing trans-specific healthcare needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific healthcare needs. The most prevalent negative trans-specific experience with HIV physicians reported cumulatively was being told by the physician that they did not know enough about trans-related care to provide care (16.7%).

CONCLUSION

Our findings demonstrate a high prevalence of disclosure of trans identity to physicians among our trans participants. Our findings suggest trans women have similar comfort discussing trans-specific healthcare needs with their family and HIV physicians; however, negative experiences with HIV providers indicate the need for gender-affirming, trans-specific provider training.