AJPH LETTERS AND RESPONSES BARRIERS TO ENGAGING TRANSGENDER WOMEN IN HIV OBSERVATIONAL RESEARCH
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ebchook et al. emphasize the need for interventions that improve the engagement and retention in HIV care of transgender women of color.1 Transgender women have high rates of illicit drug use, mental health issues, homelessness, and HIV, and transgender women of color are even more disproportionately affected by these issues.2 As mentioned in the Rebchook et al. article, distrust of the health care community and concerns about disclosing their transgender status create barriers to health care access among transgender women. Although we completely agree with this article, we would like to add that these barriers also hinder transgender women’s participation in HIV research, including observational research, the natural predecessor to interventional research. We are currently in the first phase of a cohort study in Florida designed to gather information on HIV-positive individuals and to assess substance abuse, mental health conditions, and other factors that might influence accessibility, linkage, and health care retention. Our greatest difficulty has Letters to the editor referring to a recent AJPH article are encouraged up to 3 months after the article’s appearance. By submitting a letter to the editor, the author gives permission for its publication in AJPH. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 7 references. Submit online at www. editorialmanager.com/ajph. Queries should be addressed to the Editor-inChief, Alfredo Morabia, MD, PhD, at [email protected].
June 2017, Vol 107, No. 6
AJPH
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been in recruiting transgender individuals. From our experience, we have learned that risk of disclosure is a substantial issue in this population. We have also learned that HIV research should be combined with non–HIV-related services, given that participation in HIV research could harm the reputation of transgender women, especially those involved in commercial sex work. Moreover, we have learned that reaching the transgender population requires additional resources (e.g., hiring transgender research staff) that are often not allotted for in studies not focusing on transgender individuals. Although lack of engagement in HIV care is of great concern, we should be equally concerned with lack of engagement in noninterventional research. This research provides the scientific foundation for proper resource allocation and evidence-based interventions. Investing in studies that reach out to transgender individuals needs to become a priority in HIV research. Our research team looks forward to the future findings from the Transgender Women of Color Initiative.
in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.
EDITOR’S NOTE Rebchook et al. declined to respond.
Dilser V. Ayala, BS Gladys E. Ibañes, PhD ABOUT THE AUTHORS Both authors are with the Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami. Correspondence should be sent to Dilser V. Ayala, Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5 505, Miami, FL 33199 (e-mail: dayal001@fiu.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted March 3, 2017. doi: 10.2105/AJPH.2017.303776
CONTRIBUTORS Both authors contributed equally to this letter.
REFERENCES 1. Rebchook G, Keatley J, Contreras R, et al. The Transgender Women of Color Initiative: implementing and evaluating innovative interventions to enhance engagement and retention in HIV care. Am J Public Health. 2017;107(2):224–229. 2. Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons
Ayala and Ibañes
Letters and Responses
e9
R
ebchook et al. emphasize the need for interventions that improve the engagement and retention in HIV care of transgender women of color.1 Transgender women have high rates of illicit drug use, mental health issues, homelessness, and HIV, and transgender women of color are even more disproportionately affected by these issues.2 As mentioned in the Rebchook et al. article, distrust of the health care community and concerns about disclosing their transgender status create barriers to health care access among transgender women. Although we completely agree with this article, we would like to add that these barriers also hinder transgender women’s participation in HIV research, including observational research, the natural predecessor to interventional research. We are currently in the first phase of a cohort study in Florida designed to gather information on HIV-positive individuals and to assess substance abuse, mental health conditions, and other factors that might influence accessibility, linkage, and health care retention. Our greatest difficulty has Letters to the editor referring to a recent AJPH article are encouraged up to 3 months after the article’s appearance. By submitting a letter to the editor, the author gives permission for its publication in AJPH. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 7 references. Submit online at www. editorialmanager.com/ajph. Queries should be addressed to the Editor-inChief, Alfredo Morabia, MD, PhD, at [email protected].
June 2017, Vol 107, No. 6
AJPH
◢
been in recruiting transgender individuals. From our experience, we have learned that risk of disclosure is a substantial issue in this population. We have also learned that HIV research should be combined with non–HIV-related services, given that participation in HIV research could harm the reputation of transgender women, especially those involved in commercial sex work. Moreover, we have learned that reaching the transgender population requires additional resources (e.g., hiring transgender research staff) that are often not allotted for in studies not focusing on transgender individuals. Although lack of engagement in HIV care is of great concern, we should be equally concerned with lack of engagement in noninterventional research. This research provides the scientific foundation for proper resource allocation and evidence-based interventions. Investing in studies that reach out to transgender individuals needs to become a priority in HIV research. Our research team looks forward to the future findings from the Transgender Women of Color Initiative.
in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.
EDITOR’S NOTE Rebchook et al. declined to respond.
Dilser V. Ayala, BS Gladys E. Ibañes, PhD ABOUT THE AUTHORS Both authors are with the Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami. Correspondence should be sent to Dilser V. Ayala, Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5 505, Miami, FL 33199 (e-mail: dayal001@fiu.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted March 3, 2017. doi: 10.2105/AJPH.2017.303776
CONTRIBUTORS Both authors contributed equally to this letter.
REFERENCES 1. Rebchook G, Keatley J, Contreras R, et al. The Transgender Women of Color Initiative: implementing and evaluating innovative interventions to enhance engagement and retention in HIV care. Am J Public Health. 2017;107(2):224–229. 2. Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons
Ayala and Ibañes
Letters and Responses
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