HIV Provider Experiences Engaging and Retaining Patients in HIV Care and Treatment: "A Soft Place to Fall".

Engaging and retaining persons with HIV in care and treatment is key to reducing new HIV infections in the United States. Understanding the experiences, barriers, and facilitators to engaging and retaining persons in HIV care from the perspective of HIV care providers could help provide insight into how best to achieve this goal. We present qualitative data from 30 HIV care providers in three cities. We identified three facilitators to HIV care: providing a medical home, team-based care and strategies for engaging and retaining patients in HIV care, and focus on provider-patient relationships. We identified two main barriers to care: facility-level policies and patient-level challenges. Our findings suggest that providers embrace the medical home model for engaging patients but need support to identify aspects of the model that promote engagement in long-term HIV care, improve the quality of the provider-patient relationship, and address persistent logistical barriers, such as transportation.

Comprehensive HIV Prevention for Transgender Persons.

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

Caught between different worlds: how transgendered women may be "forced" into risky sex.

We qualitatively explored reasons why transgendered women may engage in sexual risk that could lead to HIV infection. Specifically, we conducted this investigation with transgendered women identifying as Black/African American. Interviews from 17 participants were audio taped and analyzed. Four themes emerged. Women commonly reported they had a strong need/desire to be loved by men. Many stated they had and would engage in unprotected sex to obtain and preserve such a relationship. Nearly all were currently using female hormones. Nine obtained their hormones through non-medical means including the Internet, transgendered friends, and street vendors. For these women hormone injections often involved sharing needles/syringes. Selling sex was a common practice and many women did so without the benefit of condom use. Finally, women experienced multiple forms of societal discrimination. By being caught between worlds (straight, gay, male, and female) transgendered women may be placed into situations where avoiding HIV risk is extremely difficult.