Structural factors associated with viral suppression among transgender women living with HIV in France.

IF 3.1 2区医学 Q3 IMMUNOLOGY

AIDS Pub Date : 2025-09-08 DOI:10.1097/QAD.0000000000004337

Margot Annequin, Marion Mora, Raymond van Huizen, Aissatou Faye, Marion Fiorentino, Christel Protière, Michel Bourrelly, Gwenaëlle Maradan, Cyril Berenger, Florence Michard, Yazdan Yazdanpanah, Anaenza Freire Maresca, Elisabeth Rouveix, Liam Bahlan, Marie Costa, David Michels, Laszlo Blanquart, Giovanna Rincon, Bruno Spire

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引用次数: 0

Abstract

Objective: France provides universal health coverage to all residents, including undocumented migrants. Most transgender women with HIV (TWH) in France are migrants from Latin America. This study aimed to describe the rate of viral suppression among TWH in France and identify structural factors influencing this outcome.

Design: Trans&HIV is a French, nationwide, cross-sectional, retrospective life-event survey and community-based research study conducted between August 2020 and June 2022. Community-based interviewers recruited and administered questionnaires to 536 TWH in 36 different HIV care units.

Methods: We calculated the rate of viral suppression in TWH on antiretroviral therapy (ART) for at least 1 year using data from medical records, and identified associated structural factors, adjusting for clinical factors, using Firth's penalized logistic regression.

Results: Of the 506 participants with complete data, 86% were non-French nationals, most (83%) were born in Latin America. Thirty percent of participants were undocumented and 75% did not have gender-concordant identity documents. Eighty-eight percent ( N = 486) had achieved viral suppression. After adjustment for clinical factors, structural factors negatively associated with viral suppression included a lack of healthcare coverage [aOR = 3.32, 95% confidence interval (95% CI) 1.23-8.66] and not having gender-concordant identity documents [aOR = 2.05, 95% CI (1.00-4.64)]. TWH receiving state medical assistance for undocumented migrants had similar viral suppression levels to those with general public health insurance.

Conclusion: Although TWH in France have a high rate of viral suppression, barriers to comprehensive health and social inclusion persist, particularly access to healthcare coverage and legal recognition of their self-identified gender. Addressing these structural obstacles through inclusive policies is essential to improve health outcomes for this population.

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法国感染艾滋病毒的跨性别妇女中与病毒抑制相关的结构性因素。

目标：法国向包括无证移民在内的所有居民提供全民医疗保险。法国大多数感染艾滋病毒（TWH）的变性妇女是来自拉丁美洲的移民。本研究旨在描述法国TWH的病毒抑制率，并确定影响这一结果的结构性因素。设计：跨性别与艾滋病毒是法国在2020年8月至2022年6月期间进行的一项全国性、横断面、回顾性生活事件调查和社区研究。以社区为基础的采访者对36个不同艾滋病毒护理单位的536名TWH进行了招募和问卷调查。方法：我们利用医疗记录数据计算了接受抗逆转录病毒治疗（ART）至少1年的TWH病毒抑制率，并利用Firth惩罚逻辑回归确定了相关的结构因素，对临床因素进行了调整。结果：在数据完整的506名参与者中，86%为非法国国民，大多数（83%）出生在拉丁美洲。30%的参与者没有证件，75%没有性别一致的身份证件。88% （N = 486）的患者实现了病毒抑制。在调整临床因素后，与病毒抑制负相关的结构性因素包括缺乏医疗保健覆盖[aOR = 3.32, 95%可信区间（95% CI） 1.23-8.66]和没有性别一致的身份证件[aOR = 2.05, 95% CI(1.00-4.64)]。接受国家无证移民医疗援助的TWH对病毒的抑制程度与拥有一般公共医疗保险的TWH相似。结论：尽管法国的TWH病毒抑制率很高，但全面健康和社会包容方面的障碍仍然存在，特别是获得医疗保险和法律承认其自我认定的性别。通过包容性政策解决这些结构性障碍对于改善这一人群的健康结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.