TRANSGENDER ISSUES IN HIV DISEASE
As part of a larger study conducted by the UCSF International HIV/AIDS Nursing Network, the present study was a secondary analysis aimed at examining the symptom experience for transgender persons. The study’s purpose was to answer the following questions: What are the frequency and intensity of symptoms in a transgender sample of HIV-infected individuals? Are there gender differences (male, female, transgender) in this sample regarding symptom experience, symptom intensity, quality of life and engagement with health provider?
Rationale/Conceptual Basis/Background
A recent study by Baral et al. (2013) found that worldwide; transgender women had an odds ratio of 48.8 (95% CI 21.2-76.3) of contracting HIV. The Institute of Medicine (2011) found a need for transgender people living with HIV (TPLWH). The TPLWH faces multiple barriers to health and health care. Limited employment opportunities increase reliance on sex work as a means of income (Sausa, Keatley & Operario, 2007), which is found to increase risk of contracting HIV (Operario & Nemoto, 2005). Newfield (2006) found that transgender males report reduced health-related quality of life. Clement-Nolle, Marx & Katz (2006) found stigma leads to harmful behaviors and higher suicide risk due to gender-based victimization. Although symptom frequency and experience is well documented in HIV literature (Holzemer et al., 1999; Holzemer, 2002), more studies that include TPLWH are needed.
Methods
Using the baseline data from a randomized controlled trial on HIV Symptom Management (Wantland et al., 2008), people living with HIV were recruited from 14 sites (Africa, Puerto Rico and United States) in community-based organizations and hospitals. Participants (n=775; transgenders=17; females=296; males=462) completed a demographic survey, the Revised Sign and Symptoms Checklist for Persons with HIV Disease (SSC-HIVrev), Engagement with Health Care provider Instrument (HCP) and the HIV/AIDS Targeted Quality-of-Life Instrument (HAT-QoL).
Results
The data indicates that TPLWH presented with more symptoms and significantly higher symptom intensity when compared with males and females. The top five most frequently reported symptoms were painful joints (p=.001), difficulty concentrating (p=.001), depression (p=.000), muscle aches (p=.031) and weakness (p=.000) among the TPLWH, all statistically significant differences when compared with males and females. Again, comparing gender in this analysis, TPLWH reported significantly higher symptom intensity for painful joints (p=.048), concern over weight gain (p=.018), gas/bloating (p=.002), depression (p=.011) and anxiety (p=.003).
Implications
The data shows that TPLWH present with more symptoms and higher symptom intensity across gender. Symptom management for HIV support that more symptoms and symptom intensity can influence medication adherence, quality of life and decision to seek care (Lorenz, Cunningham, Spritzer, & Hays, 2006; Siegel, Schrimshaw & Dean, 1999; Spirig, Moody, Battegay & De Geest, 2005). Given the high prevalence of HIV among the transgender population, symptom experience, depression, substance abuse, violence and quality of life should be addressed by health providers. Culturally sensitive and personal plan of care for the TPLWH increases time spent with the health care provider, encourages disclosure of gender identity and other health issues, increases the quality of life and helps decrease the frequency and intensity of HIV symptoms.