Barriers and Facilitators to Integrating Gender-Affirming Care and HIV Prevention/Treatment in Illinois and Missouri: Formative Interviews with Implementation Practitioners.

Transgender people experience vast disparities in HIV prevalence, incidence, linkage to care, treatment, and prevention. Recent scholarship has highlighted that gender affirming care (GAC) may facilitate HIV treatment and HIV prevention. However, few researchers have examined how best to integrate these forms of care outside LGBT-focused clinics. Twelve interviews were conducted with key informants in community-based organizations, HIV clinics, and health departments in urban and rural Illinois and Missouri. Interviews were analyzed using a rapid qualitative analytic process, involving the production of analytic memos, coding of memos in NVivo using the Consolidated Framework for Implementation Research, and production of matrices for within-site and cross-site comparison. Key informants were highly excited at the possibility of integrating gender affirming care and HIV services. They highlighted numerous barriers that need to be targeted, including local attitudes and conditions, equity-centeredness, provider capability, and policies and laws. They also highlighted barriers to HIV care alone for transgender patients, including transportation, cost, stigma, provider capability, and homelessness. While numerous barriers exist, provider and funder acceptability are high. Attending to the needs of trans patients may support efforts to end the HIV epidemic by increasing organizational adoption of evidence-based and equity-centered interventions.