Demographic characteristics, HIV service utilization and barriers among transgender and gender non-conforming people in the Houston area

Abstract

Background: CDC reports that the highest percentage of newly identified HIV positives are among transgender people. They are overburdened by HIV and relatively under-researched in studies and underserved by healthcare providers.

Methods: A secondary data analysis was performed using data from a special needs assessment survey of HIV positive transgender people conducted in 2012 by the Houston Area Ryan White HIV Planning Council. Pearson’s chi-squared (&khgr;²) or Fisher’s exact test was conducted to assess whether HIV service utilization and barriers vary statistically by demographic characteristics. Variables with statistically significant levels less than 0.25 (P < 0.25) were selected to enter into the multivariable logistic regression models. Multivariable logistic regression with backward elimination process was used to identify the significant demographic variables that are associated with HIV service utilization and barriers.

Results: HIV positive transgender people with unstable housing status were less likely to use health insurance assistance services (P=0.012); but more likely to use substance abuse treatment services (P=0.017) and nutrition services (P=0.001) than those who owned or rented housing. They were also more likely to have difficult accessing primary health care services than those who owned/rented housing (P=0.007).

HIV positive African American transgender people were more likely to use mental health services than their white counterparts (P=0.019) and the unemployed were more likely to use mental health services than the employed (P=0.002).

More educated HIV positive transgender people were more likely to use case management services (P=0.039) and less likely to have difficulty accessing them (P=0.019) than the less educated. They had lower odds of difficulty in accessing primary HIV care (P=0.018) than the less educated.

Older transgender people (age group between 25-44) were more likely to use legal services than the younger ones (age group 18-24) (P=0.021).

Conclusion: Socioeconomic status may influence the utilization and barriers of HIV services among transgender people in the Houston Area. Housing assistance program need to be tailored to reach HIV positive transgender people of low socioeconomic status. Culturally appropriate and comprehensive transgender HIV care is recommended to meet the needs of transgender minorities in the area.