Social determinants of HIV status and viral load suppression among transgender women in South Africa: a cross-sectional analysis.
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2025-07
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Transgender women in South Africa face a heavy HIV burden, but data on key psychosocial and structural factors remain limited. This cross-sectional study examined associations between HIV outcomes and psychosocial (substance use, alcohol use, medical distrust, community connectedness) and structural (education, homelessness, income, sex work, violence) factors. We conducted interviewer-administered surveys with 213 transgender women in Cape Town, Johannesburg, and East London between June and November 2018. Of the 213 participants, 196 knew their HIV status and 67 reported living with HIV. Multivariable logistic regression found homelessness (aOR 4.50 [95%CI: 1.67, 12.23]), sex work (aOR 5.90 [95%CI: 2.14, 16.29]), and earning above the poverty level (aOR 3.08 [95%CI: 1.37, 6.94]) were significantly associated with living with HIV. Among participants with HIV, sex work (aOR 13.39 [95%CI: 1.17, 153.67]) was the only significant predictor of viral suppression. South Africa's provision of financial support specifically for PHIV may account for associations between income and HIV; while South Africa's sex-worker specific clinics, tailored to this population's needs, may account for their higher viral suppression. Study findings highlight the importance of context-specific HIV research with key populations to identify locally relevant strategies to improve HIV outcomes.
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Poteat, Tonia, Yi Liu, Darya Adams, L Leigh-Ann van der Merwe, Allanise Cloete, Lauren E Howard and Janice McCarthy (2025). Social determinants of HIV status and viral load suppression among transgender women in South Africa: a cross-sectional analysis. AIDS care. pp. 1–14. 10.1080/09540121.2025.2535471 Retrieved from https://hdl.handle.net/10161/33115.
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Tonia Poteat
Dr. Poteat is a Professor in the Duke University School of Nursing, Associate Director of the Center for AIDS Research Developmental Core, and Co-Director of the Duke SGM Wellness Program. Her research, teaching, and clinical practice focus on HIV and LGBTQ health with particular attention to the health of transgender communities. Her research attends to the role of intersectional structural stigma in driving health inequities and seeks to identify strategies to advance health justice. Certified as an HIV Specialist by the American Academy of HIV Medicine and Gender Specialist by the World Professional Association for Transgender Health, she is a global leader in HIV research and care with transgender persons. She is an associate editor for the journal LGBT Health and serves on the Department of Health and Human Services Adolescent and Adult HIV Treatment Guidelines panel. She founded and co-leads the Inter-CFAR Community Working Group and serves on the board of the World Professional Association for Transgender Health.
Lauren Howard
Lauren collaborates with different investigators in the Duke Cancer Institute on retrospective studies and clinical trials. She has experience with data management, data analysis, and preparation and editing of manuscripts. Some of her past projects have involved time-varying covariates, competing risks, and repeated measures. She is interested in methods for handling bias and confounding in observational research.
Janice Marie McCarthy
My research is focused on mathematical modeling of the dynamics of biological systems using systems of ordinary differential equations, and calibrating those equations to data. Specifically, I am interested in two distinct areas of application: within host viral/immune system modeling and models of complex antibody-antigen binding kinetics.
I believe strongly that the future direction of biomedical research is in team science. My inter-disciplinary training has provided me with the skills to communicate effectively with both biologists and mathematicians, creating a bridge that helps to unite the team and move projects forward.
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