Beyond the Individual: The Weight of Social and Structural Determinants of Depression Among Transgender Women Living with HIV in France (ANRS-Trans&HIV).

Understanding the drivers of depression among transgender women living with HIV (TWLH) is essential to developing appropriate interventions. Using data from ANRS-Trans&HIV (2020-2022), multivariable modified Poisson regressions were used to identify individual, social, and structural determinants of depression (PHQ-9 ≥ 8) among TWLH. Of 493 participants, one-third (31%) had moderate-to-severe depression. In multivariable analyses, lifetime violence, declaring harassment by strangers in public spaces because of their transgender identity, financial difficulty, and a long delay between HIV diagnosis and treatment initiation were risk factors for depression. Receiving emotional support and declaring very attentive HIV healthcare providers were protective against depression. We identified a concerning prevalence of depression among TWLH. Findings suggest that the primary determinants are social and structural, rather than individual, underscoring the need to reduce systemic transphobia and structural inequities, and improve access to gender-affirming care. ANRS-Trans&HIV is registered at ClinicalTrials.gov (NCT04849767, 2021-04-19).