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Abstract
The increasing visibility of transgender people within the American landscape necessitates increased knowledge concerning their personal networks. The goal of this cross-sectional study was to 1) describe the characteristics of the personal, health, and gender-focused networks of transgender women living with HIV (TWLH) and 2) explore the association between network support (emotional, appraisal, informational, and instrumental) and ART adherence. Mixed-venue-based convenience sampling was used to recruit (N=231) TWLH in the U.S. Participants took an 20-30-minute online survey assessing their individual characteristics and network characteristics. Means and frequencies were calculated to describe the sample and their networks. Hierarchical logistic regression models were used to predict antiretroviral therapy adherence from demographic characteristics, depression, social support, network size and density. On average participants were about 32 years old and had been diagnosed for about 4.5 years. Most identified as white (62%); nearly 27% were black. Most were employed (67.8%), stably housed (70.9%), insured (73%) and optimally adherent to ART (69%). On average, they had 4-5 confidants with whom they discussed at least one issue - they confided in nearly half of alters about multiple issues. Their networks were moderately dense (.51) and they perceived multiple forms of support from a high proportion of their network (≥ 75%). Bivariate analyses showed that participants with suboptimal adherence had higher odds of depression (r = -.21, p < .05), larger networks (r = -.26, p < .01) , and lower perceived emotional (r = .20, p < .01) and appraisal support (r = .19, p < .01) from a smaller proportion of their network. Depression (aOR = .91, p = .016) and network size (aOR = .85, p = .018) significantly and strongly predicted ART adherence in the full hierarchical model, while emotional support was marginally significant (aOR = 1.03, p = .046). Additional research is needed to understand the psychosocial dynamics of depression, ART adherence, and perceived support among TWLH. Given the pervasive use of social technology in this sample, multilevel online interventions which deliver trans-affirmative CBT while also promoting relationship management skills may minimize adherence disparities among TWLH.