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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

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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.

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Acknowledgements

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U90HA24973 in the amount of $536,244 awarded to the University of California at San Francisco. No percentage of this project was financed with non-governmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. We would also like to thank our participants and the survey administration staff at each of the demonstration sites. Dr. Johnson’s contribution to this manuscript was supported by NIDA K24DA037034.

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Authors and Affiliations

  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, Deepalika Chakravarty, Torsten B. Neilands, Starley B. Shade, Mallory O. Johnson & Greg Rebchook

  2. Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA

    Jae Sevelius, JoAnne Keatley & Greg Rebchook

  3. Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA

    Deepalika Chakravarty

  4. Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, CA, USA

    Starley B. Shade

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  1. Jae Sevelius
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  2. Deepalika Chakravarty
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  3. Torsten B. Neilands
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  4. JoAnne Keatley
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  5. Starley B. Shade
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  6. Mallory O. Johnson
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  7. Greg Rebchook
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HRSA SPNS Transgender Women of Color Study Group

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Correspondence to Jae Sevelius.

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Sevelius, J., Chakravarty, D., Neilands, T.B. et al. 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. AIDS Behav 25 (Suppl 1), 64–71 (2021). https://doi.org/10.1007/s10461-019-02544-2

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