Association Between Criminal Legal System Involvement and HIV Prevention and Care Among Transgender Women of Color: The TURNNT Cohort Study.

Abstract

Purpose: Experiences with the criminal legal system can increase the risk of HIV transmission and disrupt linkage to HIV care and prevention. This study quantified the association between criminal legal system involvement and HIV outcomes among transgender women of color (TWOC). Methods: We conducted a cross-sectional analysis using first-wave data from the Trying to Understand Relationships, Networks, and Neighborhoods Among Transgender Women of Color Cohort Study (n = 314). We investigated the association between measures of criminal legal system involvement (history of arrest and history of incarceration) and HIV care and prevention outcomes (serostatus, testing, condom use, pre-exposure prophylaxis use, and viral load suppression) among TWOC living in New York City from August 2020 to November 2022. We used modified Poisson regression models to calculate the adjusted prevalence ratios. Results: Among our cohort of TWOC, 50% had previously been arrested and 28% had previously been incarcerated. Half of the participants were living with HIV. History of incarceration was positively associated with living with HIV. Among those living with HIV, a history of incarceration was associated with an increased risk of having a detectable HIV viral load. Conclusions: Among TWOC in our study, criminal legal system involvement was significantly associated with HIV seropositivity and having a detectable viral load among those living with HIV. These findings highlight the negative health implications of the criminal legal system for a socially oppressed population and can potentially inform future directions to challenge policing practices that disproportionately target TWOC.