Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women


Autoři: Arjee J. Restar aff001;  E. Karina Santamaria aff001;  Alexander Adia aff001;  Jennifer Nazareno aff001;  Randolph Chan aff004;  Mark Lurie aff001;  Theo Sandfort aff005;  Laufred Hernandez aff006;  Susan Cu-Uvin aff001;  Don Operario aff001
Působiště autorů: Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America aff001;  The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America aff002;  amfAR, The Foundation of AIDS Research, Washington, DC, United States of America aff003;  Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong aff004;  HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division on Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America aff005;  Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines aff006;  Providence-Boston Center for AIDS Research, Providence, RI, United States of America aff007;  Miriam Hospital, Department of Medicine, Providence, RI, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224133

Souhrn

Background

Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration.

Methods

We conducted semi-structured interviews with trans women (n = 9) who self-reported as HIV-positive and their HIV providers (n = 15) from community-based venues (e.g., clinics) in Manila, Philippines.

Results

We identified five key themes from our qualitative data: (1) provider’s concerns; (2) patient’s goals; (3) affirmative vs. non-affirmative provider rhetoric; (4) alignment vs. misalignment of provider rhetoric to patient goals; and (5) FHT and ART-related decisions. Based on these themes, we describe a gender-affirmative HIV care framework to understand FHT-ART decisions among trans women living with HIV. Based on our data, this framework shows that provider-patient communications regarding ART and FHT consists primarily of provider concerns and patient goals regarding FHT. These communications can take on a gender-affirmative or non-affirmative style of rhetoric that either aligns or misaligns with patient goals and may lead to differences in FHT and ART-related decisions among trans women living with HIV.

Conclusion

There exist mixed regimens and beliefs about taking FHT and ART among this sample of trans women. While trans participants’ main source of health information is their HIV provider, providers are likely to communicate non-affirmative rhetoric that negatively impacts trans women’s decision to take FHT and ART. Research is needed to elucidate co-prescriptions of gender-affirmative services with HIV care among this group in the Philippines.

Klíčová slova:

Antiretroviral therapy – Health care policy – Health care providers – HIV – HIV epidemiology – Mental health and psychiatry – Philippines – Women's health


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2019 Číslo 10