Spatial analysis of HIV infection and the associated correlates among transgender persons in the United States

ABSTRACT

Identifying the geographic hotspots of HIV infection among high-risk populations such as transgender people is critical to ending the HIV epidemic in the United States (U.S.). This study examined the spatial pattern of HIV positivity rate and the associated correlates among transgender persons in the 48 contiguous states and the District of Columbia in the U.S. The data source was the 2015 U.S. Transgender Survey (n = 27,715). We conducted spatial analyses, with state as the unit of analysis. We fitted a spatial lag regression model to assess demographic, social, and behavioral risk variables associated with HIV. The HIV positivity rate ranged by state from 0.5% to 17.1%, with a mean of 2.9%. There was a significant positive global spatial autocorrelation (global Moran’s I = 0.42, p = 0.001). The identified spatial clusters of high values (hot spots i.e., states with high HIV positivity rates surrounded by states with similarly high rates) included five neighboring states (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee) in the Southern region. HIV positivity rate was positively associated with the percentage of transgender persons who were non-Hispanic Black, had no high school education, living in poverty, and engaged in sex work. Structural interventions are needed to address education, poverty, racial discrimination, and sex work that predispose transgender persons to HIV.

KEYWORDS:

• HIV prevalence
• gender minority
• spatial epidemiology
• U.S

Acknowledgements

The authors would like to acknowledge the National Center for Transgender Equality as the source of data for this study. Permission to use these data was given to the University of Nevada, Las Vegas, USA.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Dr. D. T. Duncan was funded in part by National Institutes of Health [grant numbers R01MH112406 and R01MD013554] and the Centers for Disease Control and Prevention [grant number U01PS005202]. Dr. D. F. Conserve was supported by a training grant from the National Institute of Health (#R00MH110343 PI: DFC) and the HIV Dissemination Science Training Program for Underrepresented Investigators grant award #R25MH080665.