"Being Diagnosed With HIV Was the Icing on the Cake of My Life": A Case Study of Fostering Resiliency Through Flexible Interventions Along the Stigma-Sickness Slope

The experiences of transgender individuals have been reflected in the stigma-sickness slope in which early stigma leads to marginalization and discrimination, placing an individual at risk for poverty and engagement in higher risk behaviors, eventually leading to sickness, such as HIV infection. For instance, the prevalence of HIV infection among transwomen is 49 times greater than among the general population. Traditional models of care provision for transgender individuals with HIV do not consider the burdens of multiple comorbidities and fear of discrimination impacting access and engagement in HIV medical care and psychotherapy. The present case study will describe how evidence- and strengths-based treatments can be flexibly integrated to promote sustained engagement in psychotherapy and improve patient outcomes. Our patient, a Latina transwoman, presented to psychotherapy at the time of her HIV diagnosis with mental and physical health concerns representative of marginalized populations. Nearly 3 years of treatment with 2 therapists in a medical setting are detailed, illustrating the realistic delivery of evidence-based care to promote minority resilience and disrupt the stigma-sickness slope. Through this case study, we present recommendations to address barriers to care.