Access to Medical and Mental Health Services Across the HIV Care Continuum Among Young Transgender Women: A Qualitative Study
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Purpose: (1) To describe psychosocial, medical, and mental health outcomes of young transgender women (YTW) living with or at risk for HIV infection and (2) to explore barriers and facilitators to medical and mental health services across the HIV care continuum. Methods: We conducted a cross-sectional observational study of YTW aged 16–24 years who were at risk for contracting or living with HIV. Participants were recruited from an adolescent HIV clinic and local community-based organizations that serve YTW. The single study visit included: a computer-assisted self-interview of demographics, medical and mental health measures, a qualitative semi-structured interview, optional rapid HIV testing for HIV-negative/status-unknown participants, and a chart review to determine rates of antiretroviral therapy (ART) prescription and viral suppression among HIV+ participants. Descriptive statistics were used for quantitative data, and a modified-grounded theory approach was used for qualitative analysis. Results: Participants (n=25) had a mean age of 21.2 years; the majority were non-white (76%), had less than a college education (76%), were unemployed (52%), and had an income <$12,000/year (80%). More than one-third were unstably housed (36%) and uninsured (36%), and 28% reported having transactional sex. A majority had taken gender-affirming hormones (72%), but 17% obtained them from a source other than their doctor. Among HIV+ participants (n=8), 50% were prescribed ART and all four participants achieved viral suppression. Qualitative themes included lack of respect for or misunderstanding of gender identity, mismatch of mental health needs with available provider skills, challenges in finding HIV prevention services during adolescence or when transitioning to adult care, and importance of workforce diversity, including representation of transgender women in care teams. Conclusion: This study identified significant unmet mental health needs and several barriers and facilitators to engaging in healthcare for YTW across the HIV care continuum. Our data suggest an urgent need for provider competency training in gender-affirming care and integration of appropriate mental health and gender-affirming treatment with HIV prevention and treatment services for this population.
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Poor mental health can decrease the intention and capacity of PLWH to engage with HIV-related care, including attending appointments and taking their medication.
“Poor mental health can decrease the intention and capacity of PLWH to engage with HIV-related care, including attending appointments and taking their medication.23,41–43”
From Mindfulness, Mental Health, and Violence Exposure Among Transgender Female Sex Workers Living with HIV in the Dominican Republic. (2026) · cites this paper as [41]
The Results (Qualitative results; page unavailable) say depression can diminish participants’ intention to engage in HIV-related services, and that HIV-positive participants described competing demands as a barrier to taking medication. The paper studies young transgender women, not PLWH generally, and does not specifically link poor mental health to missed appointments or establish it as the cause of medication nonadherence. (LLM, conf=0.86)
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Farrugia, J., Tobin, R., Cleveray, S., & Lobo, R. C. (2026) · Sexual and Gender Diversity in Social Services · doi:10.1080/29933021.2026.2633509
- Authors
- Dowshen, N., Lee, S., Franklin, J., Castillo, M., & Barg, F.
- Affiliations
- Children's Hospital of Philadelphia (US)
- University of Pennsylvania (US)
- Corresponding author
- Dowshen, Nadia
- Venue
- Transgender Health
- Publisher
- SAGE Publications
- Published
- 2017-12
- Volume
- 2
- Issue
- 1
- Pages
- 81-90
- ISSN
- 2380-193X (ISSN-L)
- PMC
- PMC5548410
- OpenAlex
- W2727079305
- Cited by
- 57
- References
- 32
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 11 · 2023: 3 · 2022: 8 · 2021: 8 · 2020: 11 · 2019: 6 · 2018: 3
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Transgender Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- University of Pennsylvania
- Penn Mental Health AIDS Research Center (P30-MH-097488)
- National Institutes of Health
- National Institute of Mental Health (K23MH102128, P30MH097488)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Keywords
- HIV care continuum, access to mental health care, health care access, barriers to care, gender-affirming hormones, antiretroviral therapy, viral suppression, HIV prevention services, workplace diversity, mental health needs, housing instability, uninsured population, transactional sex, gender identity
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