Primary Submission Category: LGBTQ+
The COVID-19 global pandemic and allostatic load among a US-based cohort of Black and Latina transgender women living with HIV
Authors: Ashleigh Rich Huijun Jiang Jenny Williams Mannat Malik L. Zachary DuBois Robert Paul Juster Tonia Poteat
Presenting Author: Ashleigh Rich*
Background: This study investigated impact of COVID-19 on stress biomarkers and allostatic load for Black and Latina transgender women living with HIV (BLTWLH), as well as COVID-19 infection, hospitalization, and vaccination.
Methods: LITE Plus is a longitudinal cohort study of BLTWLH designed to identify pathways linking biopsychosocial stress to HIV co-morbidities. Cohort enrollment was October to June 2022, inclusive. Fisher’s exact and Mann-Whitney U tests compared key biomarkers and allostatic load index (ALI) scores pre- (to March 2020) and post-COVID (January 2021 to December 2022). Frequencies and proportions are reported for COVID-19 indicators.
Results: Of the cohort, 26 BLTWLH completed study visits both pre- and post-COVID. Baseline mean age was 48 years (range 20-66). Post-COVID, chronic stress biomarkers were elevated across all body systems for BLTWLH; however, only systolic blood pressure was statistically significant. Sample allostatic load distribution shifted post-COVID (pre- mean: 3.9, sd: 2.3, median: 4.0, range: 1.0-8.0; post- mean: 4.2, sd: 2.3, median: 4.5, range: 0.0-9.0), with more individual ALI scores above the median post-COVID. Of the 89 participants who completed any post-COVID visits 16% had ever tested positive for COVID-19 and 14% reporting a related hospitalization. COVID-19 vaccination uptake was 70% and 20% had received a booster. Of those unvaccinated, 15% intended to be vaccinated, 9% were unsure and 6% did not. BLTWH employed multiple strategies to cope with pandemic effects and 24% reported unmet support needs.
Conclusions: ALI for BLTWLH was high compared to other populations in the literature, suggesting unique vulnerability to biopsychosocial stress and chronic disease risk for BLTWLH at the intersections of multiply marginalized social locations. Despite high engagement with COVID prevention including vaccination uptake and intention, BLTWLH experienced heavy COVID-19 hospitalization burden and unmet support needs.