Cross-sectional and Longitudinal Association Between Sleep and HIV Prevention and Care Behaviors Among Transgender Women of Color: The TURNNT Cohort Study.

We investigated the association between sleep health and HIV care and prevention outcomes among transgender women of color (TWOC). We used data from TWOC living in New York City collected from 2020 to 2022. Our exposures of interest were short sleep (sleeping for less than seven hours per night), poor-quality sleep (self-rated quality of sleep as “very bad” or “fairly bad”), and long sleep onset latency (taking at least 30 min to fall asleep). We asked participants about their HIV care and prevention outcomes, including HIV/STI testing, condom use, PrEP use, and HIV viral load suppression. We used Targeted Maximum Likelihood Estimation to estimate the association between sleep and these outcomes and included age, education, income, US-born nativity, and hormone replacement therapy use as potential confounders. Among the 314 participants, 54.5% had short sleep, 35.0% had poor-quality sleep, and 24.8% experienced long sleep onset latency. Among people living with HIV (51.6%), those who had short amounts of sleep were less likely to always use a condom (Adjusted Prevalence Ratio [aPR]: 0.67; 95% CI: 0.51–0.87) and be virally suppressed (aPR: 0.87; 95% CI: 0.79–0.96), and those who had poor-quality sleep were less likely to be virally suppressed (aPR: 0.83; 95% CI: 0.72–0.96). Among people living without HIV (46.2%), experiencing long sleep onset latency decreased the likelihood of always using condoms (aPR: 0.36; 95% CI: 0.15–0.85). Improving sleep health among TWOC could improve HIV care and prevention outcomes and reduce health inequities.