Introduction
Los Angeles County (“LAC”) is home to the second-largest community of people living with HIV/AIDS (“PLWH”) in the U.S. Currently, an estimated 58,000 PLWH reside in the county, a figure that has steadily increased over time. Epidemiological data confirm that 5,322 females are documented as living with HIV throughout Los Angeles County. The 2013 HIV transmission rate in LAC among cisgender(non-transgender) women was three in 100,000.
In 2013, the Williams Institute designed the Legal Assessment of Needs Study (“LeAN Study”) to examine the legal needs of PLWH in LAC. The study focused on particularly vulnerable members of the HIV-positive community, including low-income and unemployed individuals. Almost all respondents were accessing community-based social services and safety net programs at the time of the study. Research studies focused on legal services for PLWH are limited, and to date, little research has been done to assess the unmet legal needs of PLWH, including cisgender women living with HIV.
Legal Assessment of Needs (“LeAN”) Survey
This report summarizes findings of the LeAN Study for cisgender women living with HIV in Los Angeles County. We describe respondents’ legal needs, respondents’ experiences getting assistance for identified legal needs from both legal and non-legal sources, and barriers respondents faced in accessing assistance from both legal and non-legal sources. We describe differences and similarities between cisgender women and all other respondents. Finally, we discuss how these legal needs may relate to health care access and health status.
The LeAN Study survey included 387 respondents who identified as PLWH. Overall, respondents identified as cisgender men (69%), cisgender women (21%), and transgender women (9%) with a mean age of 49 years (SD = 10.6, age range 20-77 years). Almost half of the respondents (48%) reported living with AIDS. Respondents identified their race/ethnicity as Hispanic, Latino or of Spanish origin (44%), Black or African American (37%), White (17%), American Indian/Alaskan Native (6%), and Asian/Pacific Islander (1.6%). Respondents resided in 111 unique zip codes spread across LAC, including the Metro (43%), South L.A. (21%), South Bay (16%) and San Fernando (11%) areas.
Eighty-two of the total respondents, or 21%, identified as cisgender (non-transgender) women. Of these women, nearly half (49%) identified as monoracial Black or African American, compared to only 27% of male and transgender respondents. Cisgender women also identified as Hispanic, Latina or of Spanish origin of any race (34%), monoracial White (10%), and multiracial (7%). Cisgender women were also much more likely to identify as straight than other survey respondents (88% versus 21%, respectively). Five percent of cisgender women respondents identified as gay/lesbian, and 5% identified as bisexual. Their mean age was 52 (SD= 10.2, range 28-70 years), about four years older on average than the rest of the survey respondents. Cisgender women respondents reported residing in 49 unique zip codes spread across the following areas: South L.A. (37%), Metro (29%), South Bay (22%), San Fernando (4%), East L.A. (4%), San Gabriel (4%) and West L.A. (1%) areas. These women reported living in South L.A. more often than expected compared to the rest of the survey respondents, of whom only 17% reported living in South L.A.
Cisgender women were significantly more likely to report having children than other survey respondents (84% versus 22%, respectively). As compared to all other respondents, cisgender women reported a lower level of formal education (67% received a high school education or below compared to 54% of other respondents). Cisgender women were less likely to report being currently employed than other respondents (9% vs. 20%, respectively) and more likely to report being homemakers than other respondents (11% vs. 1%, respectively).
No significant differences were observed between cisgender women and other respondents with regard to self-reported income. Fifty percent of respondents reported household incomes of less than $10,000 per year, and 78% of respondents reported household incomes under $20,000 per year. For cisgender women, 53% reported household incomes of less than $10,000 per year, and 75% of respondents reported household incomes under $20,000 per year. Encouragingly, similar to the survey respondents as a whole, cisgender women also reported high rates of being linked to care (99%), retained in care (95%), being prescribed anti-retroviral medication in the last year (94%) and being informed as having an undetectable viral load in the past year (88%).