High Rates of Recent Substance Use Among Transgender People with HIV Associated with Riskier Sexual Behavior

Author: Elana Rosenthal, Phyllis Bijole, Rahwa Eyasu, Emade Ebah, Grace Garrett, Tina Liu, Ashley Davis, Meredith Zoltick, Omar Harfouch, Miriam Jones, Randy Kier, David Sternberg, Sarah Kattakuzhy

Theme: Epidemiology & Public Health Research Year: 2023

Background: Transgender(TG) people, and people with HIV(PWH) are have higher rates of substance use than the general population. We sought to understand the rates of substance use in a cohort of TG-PWH, and associations with HIV outcomes and risk behaviors.

Methods: PATCH is a longitudinal natural history study of transgender individuals in Washington, DC accessing a low-barrier gender-affirming hormone therapy (GAHT) clinic. Participants complete laboratory assessments and surveys assessing demographics, behaviors, and non-marijuana drug use patterns. Recent drug use was defined as use within one month. Fisher’s exact test was used for statistical analysis.

Results: 51 TG-PWH were predominately female gender(80%), assigned male at birth(100%), Black race(94%), and median 37 years. 63% endorsed drug use within 12months, most commonly with cocaine(49%), hallucinogens(29%), and amphetamines(29%). 43% endorsed recent drug use, of whom 59% used daily or more.

TG-PWH with recent drug use were significantly more likely to have had sex(100% vs 79%;p=0.03), >10 sex partners(41% vs 10%;p=0.02), chemsex(73% vs 28%;p=0.0002), condomless chemsex(68% vs 24%;p=0.004) and transactional sex(68% vs 17%;p=0.0004) within 12months of screening than those without recent drug use. TG-PWH with recent drug use were less likely to be on GAHT(32% vs 66%;p=0.02). Recent drug use was not associated with being on ART(77% vs 97%;p>0.05), HIV viral load suppression(55% vs 72%;p>0.05), or STI positivity(33% vs 15%;p>0.05).

Conclusions: Among TG-PWH, we found high rates of recent substance use associated with riskier sexual behavior than those without recent substance use. However, rates of STI positivity and HIV viral suppression were similarly suboptimal. These data reinforce the importance of addressing sexual health among TG-PWH, especially those with recent substance use. Given low rates of GAHT among individuals with recent substance use, providing access to GAHT may serve as an opportunity to further engage this population in treatment for substance use and associated infections.

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