Health Care Use and HIV-Related Behaviors of Black and Latina Transgender Women in 3 US Metropolitan Areas: Results From the Transgender HIV Behavioral Survey.

PURPOSE: HIV prevalence estimates among transgender women in the United States are high, particularly among racial/ethnic minorities. Despite increased HIV risk and evidence of racial disparities in HIV prevalence among transgender women, few data are available to inform HIV prevention efforts. METHODS: A transgender HIV-related behavioral survey conducted in 2009 in 3 US metropolitan areas (Chicago, Houston, and Los Angeles County), used respondent-driven sampling to recruit 227 black (n = 139) and Latina (n = 88) transgender women. We present descriptive statistics on sociodemographic, health care, and HIV-risk behaviors. RESULTS: Of 227 transgender women enrolled, most were economically and socially disadvantaged: 73% had an annual income of less than $15,000; 62% lacked health insurance; 61% were unemployed; and 46% reported being homeless in the past 12 months. Most (80%) had visited a health care provider and over half (58%) had tested for HIV in the past 12 months. Twenty-nine percent of those who reported having an HIV test in the past 24 months self-reported being HIV positive. Most of the sample reported hormone use (67%) in the past 12 months and most hormone use was under clinical supervision (70%). Forty-nine percent reported condomless anal sex in the past 12 months and 16% reported ever injecting drugs. CONCLUSION: These findings reveal the socioeconomic challenges and behavioral risks often associated with high HIV risk reported by black and Latina transgender women. Despite low health insurance coverage, the results suggest opportunities to engage transgender women in HIV prevention and care given their high reported frequency of accessing health care providers.

Agency discretion and public health service delivery.

OBJECTIVE: To study how changes in law shape the public health system. DATA SOURCES: State newborn screening laws and the National Newborn Screening and Genetics Resource Center (NNSGRC). STUDY DESIGN: A time-series, quasi-experimental design spanning the years 1990-2006 for all states and the District of Columbia was conducted. Analysis proceeded using a multinomial logit with a dependent variable of whether agencies lagged behind, were on target with, or led their newborn screening law. Explanatory variables of three different types of limitations on agency discretion plus relevant controls were included in the model. DATA COLLECTION: State laws were coded for three types of discretion: whether an agency can choose a state's newborn screening panel conditions, whether an agency can charge and change newborn screening fees, and whether the agency can define their own newborn screening criteria. Each state's newborn screening law for each year in the dataset was coded with respect to the mandated number of conditions on a panel and compared with the NNSGRC dataset of actual newborn screening implemented in the state. PRINCIPAL FINDINGS: States that lack condition discretion have 6.02 greater odds of lagging behind newborn screening law, but the presence of criteria discretion results in 7.50 higher odds of lagging behind the law. Condition discretion and fiscal discretion are associated with successful implementation. The presence of criteria discretion is a barrier for successful implementation. CONCLUSIONS: Agency discretion can both hinder and facilitate program implementation. Thus, type of discretion determines implementation.