Primary Submission Category: LGBTQ+
Economic marginalization, intersecting oppressions, and HIV health inequities among trans and nonbinary people: Community leader perspectives
Authors: Emily Paine Dennis Rivera-Cash
Presenting Author: Emily Paine*
Compared to cisgender peers, trans and nonbinary (TNB) people in the U.S. experience severe economic hardships, including high rates of homelessness and housing precarity, unemployment, food insecurity, and debt. Disadvantages are concentrated among those who have sex with men, and racial and ethnic minorities. Additionally, TNB people who have sex with men (TSM) experience high HIV prevalence, low engagement in care, and suboptimal rates of adherence to HIV medication, among other poor HIV health outcomes. How and what multiple, simultaneously occurring forms of economic hardships—termed economic marginalization—are shaping TNB people’s abilities to avoid HIV acquisition and engage in the HIV care continuum, however, is not known. We interviewed 37 TNB community leaders in three U.S. cities with dense populations of TNB people and high HIV prevalence: New York City, the San Francisco Bay Area, and Atlanta. Interviews were conducted in 2021 and 2022 and took place over Zoom. We took an abductive analytic approach and used a flexible coding strategy. Participant narratives emphasized processes through which intersecting forms of structural oppression resulted in key forms of economic marginalization of TNB people. For example, leaders identified how TNB young people facing family rejection lost their homes and family economic safety net and transitioned into homelessness, housing precarity, and lack of access to safe employment, education, and savings. Leaders further shared processes through which economic marginalization inhibited TNB people’s engagement in HIV prevention and the HIV care continuum. For example, that TNB who simultaneously lacked access to safe housing and safer employment options engaged in forms sex work that increase HIV risk, and housing precarity diminished the ability of TNB people manage HIV medications. Study results can better inform interventions designed to improve HIV outcomes among TNB people.