Patterns of Exposure to Socio-structural Stressors and HIV Care Engagement Among Transgender Women of Color

Anna L. Hotton*, Judy Perloff, Josie Paul, Channyn Parker, Kelly Ducheny, Trisha Holloway, Amy K. Johnson, Robert Garofalo, James Swartz, Lisa M. Kuhns

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Transgender women are disproportionately affected by HIV and experiences of social adversity that may interfere with engagement in care and viral suppression. We used latent class analysis to examine patterns of social adversity and their impact on HIV care continuum outcomes in an urban sample of transgender women of color. Participants (n = 224) were median age 29 and 86% non-Hispanic Black. Lack of resources, unemployment, and housing instability were reported by over 50%, and 41% reported history of incarceration. Latent class analysis identified 2 distinct classes representing higher and lower levels of social adversity. In latent class regression, membership in the higher social adversity class was associated with statistically significantly lower odds of viral suppression and HIV care engagement in univariate analysis; when adjusted for age, race, and recruitment site the association remained statistically significant for viral suppression (aOR 0.38, 95% CI 0.18–0.79; chi-square = 6.681, d.f. = 1, p = 0.010), though not for HIV care engagement. Our findings highlight the impact of socio-structural barriers on engagement in the HIV care continuum among transgender women.

Original languageEnglish (US)
Pages (from-to)3155-3163
Number of pages9
JournalAIDS and behavior
Issue number11
StatePublished - Nov 1 2020


  • Care engagement
  • HIV
  • Socioeconomic marginalization
  • Transgender
  • Viral suppression

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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