Wellbeing of trans and gender‐diverse people with HIV in the United Kingdom: Results from Positive Voices 2022

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OBJECTIVES: This national cross-sectional observational study aimed to assess mental health, quality of life, supportive network, experiences of HIV-related stigma in healthcare and unmet service need among trans and gender-diverse people with HIV, compared to cisgender people with HIV. METHODS: Positive Voices 2022 is a questionnaire survey of people accessing HIV care in England, Scotland and Wales carried out in 2022 and 2023 that included measures of depression and anxiety symptoms and suicidal ideation (PHQ-9 and GAD-7), health-related quality of life (EQ-5D-5L), supportive network (modified Duke FSSQ), experiences of HIV-related stigma in healthcare and service needs. Logistic and ordinal logistic regression assessed the association of gender identity with these measures unadjusted and adjusted for age group and ethnicity. RESULTS: Overall, 67 trans or gender-diverse and 4551 cisgender people with HIV participated. Compared to cisgender participants, trans and gender-diverse participants were younger, more likely to be Asian and less likely to be black. They were less likely to be in employment, homeowners and financially secure. Trans and gender-diverse participants had a higher prevalence of depression symptoms (35.5% [22/62] vs. 20.5% [865/4219], adjusted odds ratio [aOR] [95% confidence interval, CI] = 1.96 [1.15, 3.34]; p = 0.014) and suicidal ideation (37.1% [23/62] vs. 14.6% [616/4219]; aOR = 3.09 [1.85, 5.17]; p < 0.001) compared to cisgender participants. They also had poorer health-related quality of life for three domains (anxiety and depression, usual activities and self-care) and lower levels of supportive network in unadjusted and adjusted analyses. A higher proportion of trans and gender-diverse participants than cisgender participants had unmet needs for health services, including mental health services (49.2% [31/63] vs. 30.2% [1310/4343]; aOR = 2.02 [1.22-3.35]; p = 0.007), lifestyle services, and welfare and social services. CONCLUSIONS: Trans and gender-diverse people with HIV have poorer mental health and wellbeing than cisgender people with HIV, and a higher prevalence of unmet service needs, highlighting the need for access to culturally competent mental health and other health and welfare services.