Combining Cohorts for Equity: Understanding Comorbidities in Diverse Women

Background

Women make up a quarter of people with HIV in the US, and the majority of women living with HIV (WLHIV) are Black and/or Latina. Among WLHIV whose gender identity aligns with their sex at birth (ciswomen), 59% are Black and 19% are Latina. Forty-four percent of WLHIV whose gender identity differs from their sex at birth (trans women) are Black and 25% are Latina. Depression and traumatic stress are common among WLHIV and associated with poor health outcomes, including increased risk for cardiovascular disease (CVD). Comparing frequency of common mental health issues (such as depression and traumatic stress) is an essential first step toward understanding different factors and tailoring interventions. Cis and trans WLHIV are also more likely to be victims of violence. Understanding violence patterns and associated health outcomes by gender identity may help providers conduct the most appropriate screening and referrals for services.

Black and Latina women are significantly affected by poor mental health, violence victimization, and cardiovascular disease (CVD). These disparities are worse among women with HIV and may be influenced by gender identity and hormone use. However, few studies include both transgender(trans) and cisgender(cis) women across HIV status. This limits the ability to understand and address how hormone exposure (e.g. contraception, gender-affirmation), HIV disease, race, and gender identities impact these leading causes of poor health and death.

Moreover, mental health, violence, and CVD have complex relationships with one another. Combining data on diverse women at risk for HIV and living with HIV would provide a unique opportunity to explore these relationships.

Objective

Depression, stress, experiences with violence, and cardiovascular disease (CVD) are common among women, particularly Black and Latina women. These disparities are worsened among women with HIV and may be influenced by gender identity and/or hormone use. Moreover, mental health, violence, and CVD have complex relationships with one another. There are few studies of these leading causes of poor health and death that include both transgender and cisgender women. This limits our ability to understand and address how types of hormone exposure (e.g. replacement therapy, contraception, gender-affirmation), HIV status, race/ethnicity, and gender identity impact outcomes. Existing groups of diverse women with HIV and at risk for HIV provide an opportunity to understand these relationships by combining data to analyze. The goal of this study is to show the feasibility of combining and analyzing data from multiple groups of HIV-positive and HIV-negative transgender and cisgender women. This will help examine the health effects of multiple conditions by gender identity, HIV status, and race/ethnicity. This innovative study will use existing cohorts to establish a structure for a combined dataset following outcomes among these groups over time. This will also provide important preliminary data for a grant application to National Heart, Lung, and Blood Institute (NHLBI) in response to their Notice of Special Interest entitled, “Leveraging existing HIV observational cohorts to study HIV-associated HLBS disorders.” Ultimately, this research will have significant relevance by informing guidelines for CVD prevention, hormone therapy, violence screening and prevention, and mental health care in clinical practice.

Outcomes

This study will demonstrate the feasibility of combining and analyzing data from multiple cohorts of trans and cis women over time. At the end of the study, we will produce a combined dataset from three existing groups of HIV-positive and HIV-negative cis and trans women to explore and compare experiences of mental health, violence, and cardiovascular health. This study will provide important data for a grant application to the National Heart, Lung, and Blood Institute. Ultimately, this research will be important for informing clinical practice guidelines appropriate for gender diverse women.

Study Team/Roles

Tonia Poteat, PhD, PA-C, MPH: Principal Investigator
Ada Adimora, MD: Co-Investigator
Andrea Wirtz, PhD: Co-Investigator
Katie Mollan, MS, : Statistician
Jean Jiang: Data Analyst

Partner Organizations

Whitman Walker Health, Washington, DC
Fenway Health, Boston, MA
South Carolina HIV Planning Council, Columbia, SC
University of South Carolina, Columbia, SC
South Carolina Department of Health and Environmental Control, Columbia, SC
Mecklenburg County Health Department, NC
Medical University of South Carolina, Charleston, SC
Roper St. Francis Healthcare, SC
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Equality North Carolina, Raleigh, NC
University of Arkansas College of Public Health, Little Rock, AR
University of Georgia College of Education, Athens, GA
TRANSnetwork: Trans Health Research and Advocacy Network in the South

Funding Source

May 2020 – April 2021

Last updated: 7/28/2020