Adapting contingency management to link and retain HIV-infected transgender women of color in HIV care

Background HIV prevalence among transgender women is estimated to be 50 times greater than that of nontransgender adults, and yet HIV-positive transgender women exhibit low rates of linkage to and retention in HIV primary care, trends which are exacerbated among substance-using and minority transgender women. Transgender women experience a number of psychosocial challenges specific to their gender identification, including discrimination, prejudice, stigmatization, and social/economic marginalization. Such issues stand as obstacles to engagement and retention in medical care, substance abuse treatment, and mental health and social services. Transgender women report discrimination and/or blatant verbal abuse at standard health-care facilities. In response to this health disparity, The Alexis Project combines an innovative application of Contingency Management (CM), in conjunction with Peer Health Navigation (PHN), to improve linkage to and retention in HIV primary care, and achieve viral load suppression among HIV-infected transgender women of color in Los Angeles County.