The prevalence of HIV is particularly high among transgender women. Given the scarcity of longitudinal studies on this community in Europe, a research team from Inserm, Sorbonne Université, and hospital institutions examined the HIV care continuum over three decades. Based on data from the ANRS CO4-FHDH cohort, this study is the first in Europe to comprehensively analyze the time intervals between key stages of the care pathway and the determinants associated with initiating antiretroviral (ARV) treatments.
The findings, published in October 2026, show a notable improvement in care management. The delay in ARV initiation decreased from 4 months to 15 days between 1997-2004 and 2013-2023, likely due to the 'universal treatment' policy implemented in 2013. The median time to achieve viral suppression also shortened, from six months to approximately two months. The proportion of transgender women living with HIV on ARV with viral suppression increased from 74.7% to 95.5%, meeting UNAIDS targets.
However, the study revealed significant disparities related to geographical origin. While the majority of participants (65%) were born in Latin America, transgender women born abroad were 32% to 35% less likely to initiate treatment promptly compared to those born in France. These delays may be attributed to administrative barriers in accessing state medical aid (AME), housing, or residency permits.
“"Transgender women face intersecting social and structural barriers, particularly among migrants, which hinder equitable access to HIV-related care. Our findings and those of other studies like Trans&VIH underscore the need for structural, health, and community interventions to remove these obstacles."
The authors emphasize the importance of removing these administrative hurdles to ensure immediate and equitable access to treatment for migrant populations. In the future, the widespread use of long-acting injectable antiretroviral treatments could mark a new turning point in managing people living with HIV by facilitating adherence, especially for key populations like transgender women. However, their deployment will require vigilance against risks of follow-up interruption.
