{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:41:50Z","timestamp":1784011310595,"version":"3.55.0"},"reference-count":56,"publisher":"American Public Health Association","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p> The prevalence of HIV among transgender women (TGW) in India is disproportionately high, estimated at 4% to 8% in comparison with the national average of 0.2%. Despite free antiretroviral therapy (ART) provided by the government, TGW encounter multilevel barriers\u2014including stigma, poverty, and lack of gender-affirming care\u2014that hinder HIV care access and retention. Existing behavioral frameworks fail to address the compounded effects of systemic oppression on the health of TGW with HIV in India. <\/jats:p><jats:p> We present a conceptual framework integrating syndemic theory and intersectionality to examine structural and syndemic factors shaping HIV care barriers. Informed by key informants\u2014including TGW with HIV, community leaders, health providers, and Indian researchers\u2014the framework highlights how systemic marginalization, particularly through discriminatory policies, shapes social position and exacerbates inequities in HIV care outcomes. It also underscores the role of community mobilization and collective action in overcoming these barriers. <\/jats:p><jats:p> The framework provides a foundation for interventions tailored to the needs of TGW. By centering community-driven strategies and addressing structural inequities, it offers a pathway to improve HIV care engagement and health outcomes among TGW in India. ( Am J Public Health. 2025;115(8):1245\u20131253. https:\/\/doi.org\/10.2105\/AJPH.2025.308046 ) <\/jats:p>","DOI":"10.2105\/ajph.2025.308046","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T15:59:57Z","timestamp":1746115197000},"page":"1245-1253","source":"Crossref","is-referenced-by-count":7,"title":["Transgender Women in India: A Syndemic and Intersectional Framework Addressing HIV Care Gaps"],"prefix":"10.2105","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-2710","authenticated-orcid":false,"suffix":"II","given":"William","family":"Lodge","sequence":"first","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruta","family":"Rawat","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpana","family":"Dange","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madina","family":"Ag\u00e9nor","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek R.","family":"Anand","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Operario","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Mimiaga","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. Madina Ag\u00e9nor is with the Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Katie B. Biello is with the Department of Epidemiology, Brown University School of Public Health, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5017-5699","authenticated-orcid":false,"given":"Katie B.","family":"Biello","sequence":"additional","affiliation":[{"name":"William W. Lodge II is with the Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY. At the time of this study, Shruta Rawat, Alpana Dange, and Vivek R. Anand were with The Humsafar Trust, Mumbai, Maharashtra, India. 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