Hello. My name is Andrea Wirtz. I'm a
faculty member at Johns Hopkins University, and today
I'm going to present some preliminary
findings from the LITE cohort.
LITE is a multi-site study that has enrolled
almost 1,500 participants in the baseline survey.
This includes 747 transgender women with a negative
HIV test and 273 with a positive test at baseline.
These participants participate at partner sites in
New York City, Boston, Baltimore, Washington DC,
Atlanta, and Miami.
Briefly, participants with a negative baseline test are
eligible to continue in the cohort
and complete surveys and rapid HIV tests every three
months, as well as annual STI testing.
We also follow a separate online cohort that includes
468 participants from 50 cities in Eastern and
Southern U.S., which participates only via
remote methods.  Given that the methods for the online
cohort are a bit different, the online online cohort data
are not included in today's presentation.
While the original focus of the cohort
was to understand more about HIV risks that are unique
to transgender women, the survey is broad to allow us to
evaluate other health and social concerns.
All surveys and measures are available in English and
Spanish, and we work closely with our Community
Advisory Board that reviews the methods and study
progress.  In Baltimore, we've enrolled
131 transgender women. Among these participants,
41-percent were living with HIV at baseline.
Our catchment area is quite broad. Participants
generally come from Baltimore City, but some travel
significantly further outside of the City.
The next few slides show Baltimore-specific
data alongside data from the full cohort
including Baltimore City.  This is not meant for
comparison purposes, but to display findings for
the wider participants across the Eastern and
Southern U.S.
Consistent with the demographics of the City,
the majority of participants in Baltimore identify as
non-Hispanic Black or multiracial.
There are notable challenges with about one quarter,
who have lower literacy levels and only one-third who
report full- or part-time employment.
These two points likely reflect historical discrimination
in education and employment.  Likely related to the
last point, almost two-thirds of participants report
engagement in sex work at one point in their lifetime.
It is worth noting that these data were collected prior
to the COVID-19 pandemic, so it is possible that
some of these findings around employment status
have changed since then.
There are other notable immediate challenges,
including high levels of food insecurity, unstable
housing, and experiences of arrest.
On a positive note, however, the vast majority report
that their health is good to excellent.
One of the most salient findings from this research is
the high level of violence victimization
reported by transgender women.
Over one-third of participants reported an experience of
violence within the last three months, and almost
85-percent report lifetime experiences of violence.
To put this in perspective, the most commonly reported
statistic is that one in three cisgender women
experience violence in their lifetimes
Unlike other populations for whom intimate partners
are the most common perpetrators of violence,
LITE participants report that strangers, family members,
as well as current or former partners,
were common perpetrators of violence.
In our prospective data it's worth noting that participants
can often continue to report violence over time,
and about 40-percent of participants who
reported a recent experience of violence continue
to report that over subsequent follow-up visits.
This highlights the fact that violence is prevalent, but is also
persistent for transgender women.
Related to other discussions in this meeting, we asked
participants about common barriers to health care
they face. This slide displays results for Baltimore
participants, and is stratified by baseline HIV diagnosis.
Transportation related barriers are one of the leading
challenges participants face, though we see this is quite
different for participants who are
not diagnosed with HIV.
Halfway down on the graph, you'll see another
transportation related barrier, which is concern about
safety in transit to and from a provider's office.
Related to an earlier slide about experiences of violence
victimization, several participants have reported
experiencing violence simply
waiting at a bus stop.
I think it's also important to remember from the
provider's perspective, that what we may perceive as
a simple trip to a health clinic requires some
transgender women to weigh the potential benefit
of the medical visit against their own safety.
participants also reported significant barriers related
to perceived or experienced stigma and
discrimination in the health care setting.
Collectively, almost half of participants reported
at least one barrier related to poor experiences
in the past, feeling that providers were uncomfortable
caring for trans patients, or being mistreated
by staff or other patients.
In planning HIV prevention and care services
in Maryland,  it's important to remember that
these services will have limited impacts
if more immediate socio-economic needs, such as
employment and housing, are not supported
for transgender women.
LITE participants recognize the risk of HIV and the
importance of prevention and care, but these
socio-economic challenges, violence and other issues
take priority.
I'd like to close by thanking the
Transgender Response Team for their support.
Regularly meeting with other folks who are
dedicated to providing affirming health and related
services has provided important opportunities to
inform the LITE study,  aid in recruiting participants,
coordinate with other activities in the City,
and share progress and study findings.
I'll close by acknowledging all the people who make
this study possible, particularly the participants, and a
special thanks to the Transgender Response Team and
to Jean-Michel.
