title: Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus.
abstract: BACKGROUND
  Transgender women have 49 times the odds of human immunodeficiency virus (HIV) infection compared to other groups, yet they are disproportionately underserved by current treatment efforts.
  
  
  OBJECTIVE
  This study aimed to examine culturally unique barriers and facilitators to engagement and retention in HIV care and strengthen efforts to mitigate health disparities, guided by the Models of Gender Affirmation and Health Care Empowerment.
  
  
  METHODS
  Through 20 interviews and five focus groups (n = 38), transgender women living with HIV discussed their experiences and life contexts of engagement in and adherence to HIV care and treatment.
  
  
  RESULTS
  Our participants faced substantial challenges to adhering to HIV care and treatment, including avoidance of healthcare due to stigma and past negative experiences, prioritization of hormone therapy, and concerns about adverse interactions between antiretroviral treatment for HIV and hormone therapy. Receiving culturally competent, transgender-sensitive healthcare was a powerful facilitator of healthcare empowerment.
  
  
  CONCLUSIONS
  Recommendations are offered to inform intervention research and guide providers, emphasizing gender affirming HIV care that integrates transition-related healthcare needs.
authors: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA, jae.sevelius@ucsf.edu.
authors: Jae M
authors: JM
authors: Sevelius
authors: Enzo
authors: E
authors: Patouhas
authors: Joanne G
authors: JG
authors: Keatley
authors: Mallory O
authors: MO
authors: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D057545:Social Stigma; D063106:Transgender Persons; D014930:Women; D008297:Male