Publications
“This is just everyday living”: Impact of the COVID-19 pandemic on transgender/gender diverse people living with HIV
2025
Manalel, J., Kaufman, J., Wu, Y., Gao, A., Antonios, V., Brandenburg, C., Scaccabarrozzi, L., Ernst, J., & Brennan-Ing, M. (2025, March 27). “This is just everyday living”: Impact of the COVID-19 pandemic on transgender/gender diverse people living with HIV [Poster presentation]. International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Toledo, Spain.
Jasmine Manalel, Jennie Kaufman, Yiyi Wu and Mark Brennan-Ing
Background
People living with HIV (PLWH) require regular and consistent engagement with the healthcare system to manage their illness, including regular visits to healthcare providers and adherence to anti-retroviral therapy (ART). The effects of COVID-19 pandemic-related disruptions to care may be amplified in vulnerable PLWH populations, including those with transgender and gender-diverse (TGD) identities. TGD individuals reported shortages in gender-affirming hormone supplies, delays in gender-affirming surgeries, and decreased access to supportive and affirming environments. In a mixed methods study, we examined the impact of the pandemic on the care engagement of TGD people with HIV.
Method
We analyzed claims and clinical records of 3,195 people with HIV aged 18 to 65 who were continuously enrolled in a managed care plan for low-income individuals in New York City from January 2018 through July 2022. The sample was predominantly cisgender male (62.4%), followed by cisgender female (28.5%), and TGD (9.1%). We used time varying effect models (TVEM) to examine changes in care engagement, including visits to primary care providers (PCP), behavioral health services, specialty care, hospitalizations, and ART fills, before and during the pandemic, and compared these across gender identities. Additionally, we conducted semi-structured interviews with 40 plan members (including six transgender women and two nonbinary participants) in fall 2023 to gain deeper insight into the pandemic’s impact on care engagement, medication adherence, community program and service participation, and well-being.
Results
TVEM results indicated that the pandemic affected the number of PCP and behavioral health visits. Cisgender men had lower levels of PCP visits compared to cisgender women, with more fluctuations over time. PCP visits among TGD individuals appeared relatively stable over time, with telehealth visits compensating for in-person visit gaps. Across all gender identities, behavioral health visits increased before the pandemic, then slowly decreased during it, but returned to pre-pandemic levels later in the study. There was little change over time for specialty visits, inpatient hospitalizations, and ART fills.
The qualitative data suggested that most other disruptions in care among TGD participants were due to other factors, such as unstable housing, rather than direct healthcare access issues. Four transgender women reported delays and challenges in coordinating gender-affirming surgeries during the pandemic. No one reported difficulties accessing hormone therapy. One transgender woman expressed a sense of resilience: “This is just a part of the situation. And this is just everyday living for a black trans woman in New York City anyway.”
Conclusions
These findings suggest that, despite pandemic disruptions, TGD individuals with HIV remained engaged in care, particularly with the support of telehealth. The interviews complemented the quantitative data, highlighting other stressors beyond transgender stigma, and corroborating the stability of ART and hormone therapy access. Although we lacked quantitative information specifically about gender affirming care, the broader literature indicates negative psychosocial impacts. Overall, these findings point to resilience of TGD people with HIV and efforts, including telehealth services, that might mitigate ongoing or future disruptions in care.