The COVID-19 global pandemic and allostatic load among a cohort of Black and Latina transgender women living with HIV.

This exploratory study investigated the impact of the COVID-19 pandemic on stress biomarkers and allostatic load for Black and Latina transgender women living with HIV (BLTWLH), as well as COVID-19 infection, hospitalization, and vaccination status. LITE Plus is a longitudinal cohort study of BLTWLH designed to identify pathways linking biopsychosocial stress to HIV comorbidities. Participants were enrolled between October 2019 and June 2022. Descriptive statistics compared stress biomarkers and allostatic load index (ALI) scores pre- (to March 2020) and postonset pandemic onset (January 2021–December 2022). Frequencies and proportions are reported for COVID-19 indicators. Of the cohort, 26 BLTWLH completed study visits both pre- and postonset pandemic onset (“preonset”; “postonset”). Postonset, chronic stress biomarkers were elevated across all body systems. Sample ALI distribution shifted postonset, with elevated mean, median, interquartile range, and proportion above the median. Of the 108 participants who completed any postonset visits, 19% had ever tested positive for COVID-19% and 4% reported a COVID-19-related hospitalization. COVID-19 vaccination uptake was 70%, and 24% had received a booster. Of those unvaccinated, 15% intended to be vaccinated, 9% were unsure, and 6% did not intend to be vaccinated. BLTWLH deployed various strategies to cope with pandemic effects and 22% reported unmet COVID-19-related support needs. ALI for BLTWLH was high compared to other populations in the literature, suggesting unique vulnerabilities to biopsychosocial stress and chronic disease risk. Despite high engagement with COVID-19 prevention including vaccination intention and uptake, BLTWLH experienced heavy COVID-19 burden and unmet support needs. This study points to unique vulnerabilities to chronic stress dysregulation with subsequent chronic disease risk for Black and Latina transgender women living with HIV. The COVID-19 pandemic may exacerbate such vulnerabilities, potentiating both short- and long-term impacts for this population. Study findings highlight the importance of collecting data on gender identity and race/ethnicity in COVID-19 research and surveillance, ensuring Black and Latina transgender women living with HIV are included in pandemic assessment, prevention and intervention.