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A Community Located Insurance Navigation Intervention to Link Sexual and Gender Minorities in Status Neutral Care:
Victoria Umutoni1,2, Rebecca Eavou2, Ellen Almirol2
1Department of Public Health Sciences, The University of Chicago, Chicago, IL.
Journal of Acquired Immune Deficiency Syndromes (1999)
|November 3, 2025
Summary
Health insurance navigation did not significantly improve linkage to care for Black and Hispanic/Latino sexual gender minorities (SGM). High baseline insurance rates may have influenced these HIV prevention and treatment engagement findings.
Area of Science:
- Public Health
- Health Disparities
- HIV/AIDS Research
Background:
- Black and Hispanic/Latino sexual gender minorities (SGM) face disproportionately high rates of HIV.
- Structural determinants of health, including insurance coverage, are critical for HIV care engagement and outcomes.
- Understanding interventions to improve care linkage for SGM is essential for reducing HIV disparities.
Purpose of the Study:
- To evaluate the effectiveness of health insurance navigation on linkage to care among Black and Hispanic/Latino SGM and transgender individuals.
- To assess linkage-to-care rates for both HIV-positive and HIV-negative participants under a status-neutral framework.
- To determine if tailored insurance navigation improves engagement in HIV care and pre-exposure prophylaxis (PrEP) services.
Main Methods:
- A randomized controlled trial enrolled 625 Black and Hispanic/Latino SGM and transgender individuals aged 18+ in Chicago, IL.
- Participants were randomized to receive health insurance navigation (intervention) or standard of care.
- Two-way contingency analyses compared linkage-to-care rates by HIV status and intervention assignment.
Main Results:
- Overall, 29.7% of participants were living with HIV (PLWH), 14.1% identified as transgender, and 68.5% had insurance at baseline.
- Among PLWH, 66.1% were linked to HIV care; among those without HIV, 23.9% were linked to PrEP.
- Health insurance navigation did not significantly improve linkage to care across study arms and HIV statuses (35.2% overall linkage).
Conclusions:
- Providing health insurance navigation before a care visit did not significantly enhance linkage to care for this population.
- The high prevalence of insurance at baseline may have limited the intervention's impact.
- Further research may be needed to identify effective strategies for improving HIV care engagement among SGM, particularly those facing insurance barriers.
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