Using Chosen Names and Pronouns in HIV Care: Clinical Outcomes
Using a person's chosen name and pronouns in HIV clinical settings improves retention in care, reduces avoidance of healthcare services, and enhances linkage to treatment—critical outcomes for reducing HIV-related morbidity and mortality. 1
Primary Outcomes
Improved Healthcare Engagement and Retention
Culturally sensitive practices, including use of chosen names and pronouns, directly influence linkage to healthcare services among HIV-positive transgender individuals. A qualitative study of HIV-positive low-income transgender women of color demonstrated that respectful use of identity markers was associated with improved connection to various healthcare services. 1
Failure to use preferred names and pronouns leads to avoidance of care or loss of patient retention when individuals feel their gender identity is not being acknowledged or respected. 1
Enhanced Patient-Provider Relationship
Using incorrect names or pronouns negatively impacts the patient-provider relationship, creating barriers to effective HIV care delivery. 1
The therapeutic alliance is strengthened when clinicians demonstrate respect through proper identification, which affects intermediate outcomes like adherence and self-care skills that ultimately influence health and well-being. 2
Safety and Quality of Life Considerations
Reduced Risk of Harm in Clinical Settings
Calling patients by incorrect names in crowded waiting areas puts them at risk for verbal or physical abuse from other patients. Approximately 28% of transgender respondents reported experiencing harassment in clinic settings, and 2% experienced physical abuse. 1
Misgendering creates situations where patients with outwardly female appearance are called by male names (or vice versa) in public clinical spaces, exposing them to discrimination and violence. 1
Mental Health Outcomes
Chosen name use is associated with large reductions in negative mental health outcomes among transgender individuals. This is particularly relevant for HIV care, where mental health directly impacts treatment adherence and viral suppression. 3
The importance of pronoun usage correlates with mental health and HIV care outcomes, demonstrating predictive validity for clinical engagement. 4
Implementation Framework
Clinical Practice Standards
The American Society of Anesthesiologists recommends confirming and using the patient's preferred name and pronouns at all times as an important way of showing respect and decreasing the risk of gender dysphoria. 1, 5
Preferred names and pronouns should be documented in medical records to prevent repeated uncomfortable conversations and ensure consistent respectful care across all clinical encounters. 5, 6
System-Level Interventions
Electronic health record systems should guide administrative and clinical staff to use patients' chosen names and pronouns to improve patient engagement and comfort while improving retention in care. 1
Quality improvement initiatives that increase affirmed name and pronoun documentation have demonstrated feasibility and potential to improve care quality for transgender patients. 7
Critical Pitfalls to Avoid
Never use legal names that differ from preferred names during clinical interactions. This practice is specifically contraindicated and can lead to patient disengagement from HIV care. 5, 6
Avoid making assumptions about how patients wish to discuss their care based on gender presentation, as this can exacerbate gender dysphoria and create barriers to treatment. 5
Do not share transgender status without patient consent unless deemed essential for safety of care, maintaining the same confidentiality standards as other sensitive personal information. 1
Clinical Significance for HIV Outcomes
The evidence demonstrates that using chosen names and pronouns is not merely a courtesy but a clinical intervention that affects morbidity through improved treatment engagement, mortality through better retention in care and viral suppression, and quality of life through reduced harassment and improved mental health outcomes. 1, 4, 3 For HIV clinicians, this practice is essential for achieving optimal clinical outcomes in transgender patients, a population already experiencing significant health disparities. 8