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. 2021 Jul;25(Suppl 1):64-71.
doi: 10.1007/s10461-019-02544-2.

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV

Jae Sevelius  1   2 , Deepalika Chakravarty  3   4 , Torsten B Neilands  3 , JoAnne Keatley  5 , Starley B Shade  3   6 , Mallory O Johnson  3 , Greg Rebchook  3   5 ; HRSA SPNS Transgender Women of Color Study Group
Affiliations

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV

Jae Sevelius et al. AIDS Behav. 2021 Jul.

Abstract

Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.

Keywords: Gender affirmation; HIV; Healthcare empowerment; Transgender; Viral suppression.

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Figures

Fig. 1
Fig. 1
Structural equation model for transgender women of color living with HIV, depicting paths and standardized estimates among transgender-related discrimination, gender affirmation, healthcare empowerment and viral suppression (N = 823). The coefficients on the arrows from ‘transgender-related discrimination’ to each form of discrimination, and from ‘gender affirmation’ to its constituents, are the standardized factor loadings of each item on to the latent factor. *p < 0.05, ***p < 0.001 for coefficients
See this image and copyright information in PMC

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