Operationalizing the Women-Centred HIV Care Model for trans women and persons with transfeminine experience living with and affected by HIV: a qualitative study

BackgroundThe Women-Centered HIV Care (WCHC) Model and associated toolkits were created to address the health care barriers and disparities that women and gender diverse people living with HIV experience. Since trans women and transfeminine people experience disproportionately high rates of HIV acquisition (in comparison to their cisgender peers) amidst biologic, social, political, and historical factors that affect their general care experiences negatively, more research is needed.AimWe aimed to obtain feedback on the WCHC Model regarding the acceptability, applicability, usability, gaps, and potential adaptations needed to meet the needs of trans women and gender diverse people with transfeminine experience.MethodsOur study was grounded in community-based research principles and intersectionality frameworks. We conducted semi-structured interviews with 17 trans women and transfeminine people residing in Ontario, Canada. We analyzed the data using a descriptive qualitative content analysis approach.ResultsParticipants were largely satisfied with the WCHC Model. However, participants were concerned with the model's implementation due to a lack of knowledge among healthcare providers regarding trans women's experiences within broader social contexts. Simultaneously, participants affirmed the need for care providers to offer person-centered care - a central component of the WCHC Model. Lastly, participants spoke to the healthcare system limitations and failures that disproportionately affected trans women and posed significant barriers to WCHC access and engagement.DiscussionOur findings demonstrate that trans women perceive successful healthcare delivery as combining holistic care frameworks - like the WCHC Model - with healthcare providers' understanding of individual and community needs. There is a need for policy reform to improve the healthcare system. We offer reflections and recommendations for improving healthcare for trans women.