Culturally Relevant HIV Prevention for Transgender Women
Transgender women are disproportionately impacted by HIV, especially transgender women of color. Twenty-five years of HIV prevention research, practice, and policy have not adequately produced evidence-based, effective prevention options for this population at disproportionately high risk for HIV acquisition and transmission. Social and contextual issues, such as severe stigma, discrimination, alienation, poverty, and victimization underlie many of the risk behaviors frequently reported among transgender women. Despite elevated risk for HIV, the rates of HIV antibody testing among transgender women are lower than other at-risk groups, and our team's research with transgender women who test HIV-positive indicates unique barriers to treatment uptake and adherence, which puts them at elevated risk of poor HIV-related clinical outcomes.
There are currently no available interventions specifically developed to meet the unique needs of high-risk transgender women that have been carefully evaluated in randomized controlled trials. To address this gap, we have developed and successfully piloted an innovative, group-based intervention that addresses the unifying lived experiences of HIV-positive, negative, and unknown status transgender women who are at elevated risk for acquiring or transmitting HIV. The Sheroes intervention was designed in close collaboration with the transgender community and distills common concerns of HIV+, HIV-neg., and unknown status transgender women. Sheroes is grounded in Social Learning Theory, the Theory of Gender and Power, and our team's work in the area of Gender Affirmation. The specific aims of the Sheroes R34 are as follows.
Primary specific aim:
- To test the efficacy of Sheroes, a theory-driven, culturally grounded intervention, to reduce sexual risk behavior (unprotected receptive/insertive anal sex) among high-risk transgender women
- To explore the effect of the Sheroes intervention on self-reported HIV testing rates among HIV-neg. and unknown status transgender women during the follow-up period
- To explore the effect of the intervention on self-reported sexually transmitted infection (STI) testing rates among all participants
- To explore differences between the experimental arm and the control arm in engagement in care among HIV+ participants