Barriers to HIV Care among Transgender Sex Workers of Colour in the USA and Canada: An Intersectional Scoping Review
Bibliographic record
Abstract
Objectives: In 2018, HIV prevalence among transgender women of color in the USA was 14.11%, with similar severe trends observed in Canada. This highlights the persistent challenge of HIV/AIDS in both countries, particularly for transgender sex workers of color (TSWOC), who face significant barriers to accessing crucial HIV/AIDS care services due to stigma, systemic discrimination, and biased healthcare practices. To address these issues, a scoping review was undertaken to explore the specific barriers to HIV/AIDS care experienced by TSWOC in the United States and Canada. Methods: After various database searches (MEDLINE, PubMed, and Google Scholar) using the PRISMA-ScR methodology, 47 studies were extracted. Studies were then screened on Covidence by using the set inclusion and exclusion criteria. After screening, fifteen studies met the criteria. Results: The results were thematically organized using an intersectionality-grounded socio-ecological model. Results revealed individual-level challenges of internalized stigma, interpersonal issues with biased healthcare providers, and community-level problems such as lack of support and enduring stigma. Notable structural barriers, consistent across studies, included homelessness, economic marginalization, and institutional transphobia. Institutionalized cisnormativity in healthcare was also found to exacerbate these challenges. Conclusions: The findings underscore a feedback loop intensifying HIV/AIDS burdens within TSWOC due to intersecting stigmas and structural disparities. The review advocates for trans-specific and trans-inclusive HIV/AIDS services to address unique challenges, emphasizing the imperative for holistic, trauma-informed HIV care for this underserved population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.047 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.019 | 0.028 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.008 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".