What Is the Importance of This Study?
Research has demonstrated that women face not only biological susceptibility to HIV, but also amplified vulnerability due to social factors such as poverty, marginalization, violence, and gender inequity. The Canadian HIV Women’s Sexual & Reproductive Health Cohort Study, or CHIWOS, was developed to identify and address these issues.
The Goals of the Study
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Assess the proportion, distribution and patterns of use and uptake of women-centred HIV care, and factors associated with service uptake among women living with HIV in Canada.
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Estimate the effect of women-centred HIV care uptake on the overall HIV, women’s, mental and sexual and reproductive health outcomes of women living with HIV in Canada.
CHIWOS & Trans Women Living with HIV
Drawing on CHIWOS data collected from 54 trans women from British Columbia, Ontario, and Quebec, and primary qualitative interviews conducted with a sub-set of 11 trans women from CHIWOS, we examined:
The HIV care cascade and factors associated with HIV care cascade outcomes
Transition and gender-affirming healthcare experiences of trans women living with HIV
Resilience and empowerment exhibited by trans women living with HIV as they navigate intersecting stigmas in healthcare settings.
Our findings suggested a need for multi-level interventions to address barriers to accessing care. Trans women living with HIV resisted and reduced stigma in healthcare settings; however, widespread stigma-reduction training for providers, administrators, and students was recommended.
Social Determinants of Health: a trans-cultural perspective
A large body of research focuses on trans women’s access to HIV prevention, yet little research focuses on their experiences of health and well-being post-diagnosis. Social factors have key implications on health:
• Simply administering medical treatment is often insufficient to improve health
• Poverty, gender inequity, and a multitude of other factors have a major impact on women’s vulnerability to health problems and (in)ability to access care and support
• Trans women have a much higher risk of HIV due to social and structural issues.
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Using CHIWOS data, we aimed to compare cis and trans women in CHIWOS across sociodemographic factors (age, race/ethnicity, sexual orientation, education), key social determinants of health (income, employment, housing and food security, social exclusion, and access to HIV-related care), and health and mental health outcomes (CD4 count, viral load, depressive and post-traumatic stress symptoms).
Mental Health and Psychological Wellbeing of Trans Women Living with HIV
Mental health is an important aspect of overall wellbeing, and is also closely linked to other aspects of health and wellbeing (e.g. sexual health, physical health, etc.). Stigma around mental health still remains a reality in many communities and when combined with the layers of stigma around gender, as well as HIV status, trans women living with HIV face a unique set of challenges when navigating their life journey. With this analysis, we aimed to characterize the prevalence of mental health conditions among trans women living with HIV in CHIWOS and to assess for associations between individual, social, clinical and structural factors and mental health outcomes for this population.