Background
Transgender and gender diverse (TGD) people with HIV may experience high prevalences of psychiatric diagnoses due to the convergence of two marginalized social identities, HIV infection and gender minority. Utilizing multi-sourced data from the All of Us (AoU) Research Program, the current study aimed to examine the impact of HIV status on psychiatric diagnoses among TGD individuals and the potential moderating effect of sex assigned at birth and race/ethnicity.
Methods
This study used AoU controlled tier data, version 7, which covers individuals enrolled in AoU from May 31, 2017, to July 1, 2022. A comprehensive computational phenotyping algorithm incorporating both electronic health records (EHRs) and survey data was used to identify suspected TGD participants in AoU. Then, four broad clusters of psychiatric disorders, including “Any mood disorder,” “Any anxiety disorder,” “Any substance use disorder,” and “Any stress-related disorder,” were identified based on ICD codes from EHR data. Multinomial logistic regression models were used to explore the association of HIV status with the number of psychiatric diagnoses clusters while also exploring the potential moderation effect of race/ethnicity and sex assigned at birth.
Results
Among 4,899 TGD individuals identified, 1,439 (29.37%) had a diagnosis in at least one cluster of psychiatric disorders, and 211 (4.31%) were with HIV. Significant correlations were observed across four clusters of disorders, with the values of correlation coefficients ranging from 0.60 to 0.92. TGD individuals with HIV had higher odds of having diagnoses in at least two clusters (Adjusted Odds Ratio [aOR] = 4.48, 95%CI: 3.13~6.49)) or one cluster (aOR = 2.36, 95%CI: 1.42~3.94) compared to TGD individuals without HIV. In addition, sex assigned at birth moderated the effect of HIV status on the likelihood of having one cluster of psychiatric diagnoses. The negative impact of HIV status on the diagnosis in at least one cluster of psychiatric disorders was more pronounced for TGD individuals who were assigned as female than those who were assigned as male at birth (aOR = 0.20, 95%CI: 0.04~0.89).
Conclusions
Comprehensive healthcare support that integrates HIV treatment and psychotherapy is needed for TGD people with HIV, and gender-affirmative approaches are needed when conducting mental health intervention for individuals with HIV who were assigned female at birth, considering their unique experience.