Recent data from the U.S estimated that over half (57%) of transgender women (TW), aged 50+, are living with HIV. Findings lacked analysis by age, gender, and race/ethnicity, but found 62% HIV prevalence among Black trans women, suggesting potential HIV disparities for older TW of color.

We conducted multi-variable analysis of baseline TETAC survey data to assess if HIV health outcomes differ for TW aged 50+ and TW aged 49 and younger and looked at variation by social determinants of health (e.g. education and income) and service utilization (e.g. mental health services, food assistance). We conducted thematic analysis with a sub-set of interviews to provide context for results.

Participants aged 50+ were more likely to be engaged in care than younger participants, with older Black TW slightly less likely to be engaged in care than Latina TW. Importantly, service use attenuated the relationship between age and engagement in care. Analysis of interviews identified ways that greater community connection, supportive relationships, and use of services were solidified over time, resulting in greater stability among older participants as compared to younger participants.

This study focused on HIV outcomes and health services access for TW aged 50 and older, making important contributions to the context of care for this population sub-group, who shoulder disproportionately high HIV prevalence. Findings highlight the critical role of support services in HIV care engagement and the potential for expanded access and intergenerational peer support programs to ameliorate HIV-related disparities based on age and race.