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

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Abstract
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.
Funding Information
  • Canada Research Chairs
  • Academic Health Science Centres
  • Santé
  • Canadian HIV Trials Network, Canadian Institutes of Health Research (CTN 262)
  • Ontario HIV Treatment Network
  • Canadian Institutes of Health Research

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