Advertisement

TransAction: A Homegrown, Theory-Based, HIV Risk Reduction Intervention for Transgender Women Experiencing Multiple Health Disparities

  • Cathy J. Reback
  • Kirsty Clark
  • Jesse B. Fletcher
Article
  • 51 Downloads

Abstract

HIV vulnerability among transgender women is symptomatic of numerous syndemic psychosocial and structural co-factors that attribute to and exacerbate HIV risk. From February 2010 to December 2017, 514 transgender women enrolled in a “homegrown” theory-based, HIV risk reduction program, TransAction, specifically designed to intervene with trans women who experience numerous co-occurring health disparities. Increased attendance in TransAction intervention sessions was associated with significant reductions in the number of male sexual partners (coef. = − 0.20), anonymous male sexual partners (− 0.30), exchange male sexual partners (− 0.25), engagement in drug/alcohol use (− 0.37), engagement in injection drug use (− 0.20), engagement in unmonitored injection hormone use (− 0.55), engagement in sex while high (− 0.23), and engagement in sex work (− 0.20; all coefficient estimates p ≤ 0.05). Results demonstrated that the homegrown HIV risk reduction intervention was successful in working with transgender women who experience multiple co-occurring syndemic conditions. Given that there has been a dearth of evidence-based interventions for this population that are designed to be delivered in resource limited settings, TransAction can serve as a model HIV risk reduction program for guiding public health departments and community-based organizations.

Keywords

Transgender HIV Health disparities Risk reduction 

Notes

Acknowledgements

This study was supported by the Los Angeles County, Department of Public Health, Division of HIV and STD Programs (formerly Office of AIDS Programs and Policy) contract PH#001039. Dr. Reback acknowledges additional support from the National Institute of Mental Health (P30 MH58107). The authors thank the staff who facilitated the TransAction program, most particularly Ms. April Saravia, for their dedication and service to the trans women in Los Angeles County.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

As outlined in the HHS Office for Protection from Research Risks guidance, the data collected for this manuscript were part of a service program and, thus, exempt from IRB review.

References

  1. Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248–287.CrossRefGoogle Scholar
  2. Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52(1), 1–26.CrossRefGoogle Scholar
  3. Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222.  https://doi.org/10.1016/S1473-3099(12)70315-8.CrossRefPubMedGoogle Scholar
  4. Bockting, W., Robinson, B., Forberg, J., & Scheltema, K. (2005). Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community. AIDS Care, 17(3), 289–303.CrossRefGoogle Scholar
  5. Bradford, J., Reisner, S. L., Honnold, J. A., & Xavier, J. (2013). Experiences of transgender-related discrimination and implications for health: Results from the Virginia Transgender Health Initiative Study. American Journal of Public Health, 103(10), 1820–1829.  https://doi.org/10.2105/AJPH.2012.300796.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Brennan, J., Kuhns, L. M., Johnson, A. K., Belzer, M., Wilson, E. C., & Garofalo, R. (2012). Syndemic theory and HIV-related risk among young transgender women: The role of multiple, co-occurring health problems and social marginalization. American Journal of Public Health, 102(9), 1751–1757.  https://doi.org/10.2105/AJPH.2011.300433.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Clark, K., Fletcher, J. B., Holloway, I. W., & Reback, C. J. (2018). Structural inequities and social networks impact hormone use and misuse among transgender women in Los Angeles County. Archives of Sexual Behavior, 1–10.Google Scholar
  8. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915–921.CrossRefGoogle Scholar
  9. De Santis, J. P. (2009). HIV infection risk factors among male-to-female transgender persons: A review of the literature. Journal of the Association of Nurses in AIDS Care, 20(5), 362–372.  https://doi.org/10.1016/j.jana.2009.06.005.CrossRefPubMedGoogle Scholar
  10. Ellemers, N. (1993). The influence of socio-structural variables on identity management strategies. European Review of Social Psychology, 4(1), 27–57.CrossRefGoogle Scholar
  11. Fisher, J. D., & Fisher, W. A. (2002). The information-motivation-behavioral skills model. Emerging theories in health promotion practice and research: Strategies for improving public health, 1, 40–70.Google Scholar
  12. Fletcher, J. B., Kisler, K. A., & Reback, C. J. (2014). Housing status and HIV risk behaviors among transgender women in Los Angeles. Archives of Sexual Behavior, 43(8), 1651–1661.  https://doi.org/10.1007/s10508-014-0368-1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Garofalo, R., Johnson, A. K., Kuhns, L. M., Cotten, C., Joseph, H., & Margolis, A. (2012). Life skills: Evaluation of a theory-driven behavioral HIV prevention intervention for young transgender women. Journal of Urban Health, 89(3), 419–431.CrossRefGoogle Scholar
  14. Glynn, T. R., & van den Berg, J. J. (2017). A systematic review of interventions to reduce problematic substance use among transgender individuals: A call to action. Transgender health, 2(1), 45–59.CrossRefGoogle Scholar
  15. Grant, J. M., Mottet, L., Tanis, J. E., Harrison, J., Herman, J., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey: National Center for Transgender Equality.Google Scholar
  16. Grossman, C. I., Forsyth, A., Purcell, D. W., Allison, S., Toledo, C., & Gordon, C. M. (2011). Advancing novel HIV prevention intervention research with MSM—Meeting report. Public Health Reports, 126(4), 472–479.CrossRefGoogle Scholar
  17. Herbst, J. H., Beeker, C., Mathew, A., McNally, T., Passin, W. F., Kay, L. S., & Chattopadhyay, S. (2007). The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: A systematic review. American Journal of Preventive Medicine, 32(4), 38–67.CrossRefGoogle Scholar
  18. Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., Crepaz, N., & Team, H. A. P. R. S. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12(1), 1–17.  https://doi.org/10.1007/s10461-007-9299-3.CrossRefPubMedGoogle Scholar
  19. Jaffee, K. D., Shires, D. A., & Stroumsa, D. (2016). Discrimination and delayed health care among transgender women and men: Implications for improving medical education and health care delivery. Medical Care, 54(11), 1010–1016.CrossRefGoogle Scholar
  20. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. A.. (2016). The report of the 2015 U.S. Transgender Survey.Google Scholar
  21. Johnson, M. O., Chesney, M. A., Goldstein, R. B., Remien, R. H., Catz, S., Gore-Felton, C., & Team, N. H. L. P. (2006). Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: A mediation model. AIDS Patient Care & STDs, 20(4), 258–268.CrossRefGoogle Scholar
  22. Kenagy, G. P. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work, 30(1), 19–26.CrossRefGoogle Scholar
  23. Kuhns, L. M., Mimiaga, M. J., Reisner, S. L., Biello, K., & Garofalo, R. (2017). Project LifeSkills-a randomized controlled efficacy trial of a culturally tailored, empowerment-based, and group-delivered HIV prevention intervention for young transgender women: Study protocol. BMC Public Health, 17(1), 713.CrossRefGoogle Scholar
  24. Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2002). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42(1), 89–101.  https://doi.org/10.1300/J082v42n01_05.CrossRefGoogle Scholar
  25. Los Angeles County Commission on HIV and the Los Angeles County Department of Public Health Division of HIV and STD Programs. (2016). Los Angeles County comprehensive HIV plan (2017-2021). Retrieved from.Google Scholar
  26. Molina, Y., & Ramirez-Valles, J. (2013). HIV/AIDS stigma: Measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women. AIDS Care, 25(12), 1559–1568.CrossRefGoogle Scholar
  27. Mustanski, B. S., Garofalo, R., & Emerson, E. M. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health, 100(12), 2426–2432.CrossRefGoogle Scholar
  28. Nemoto, T., Hsueh, M., Steuerman, K., McCree, B., & Horne, A. (2007). HIV risk behaviors and substance use among transgender women in the San Francisco Bay Area. Paper presented at the 135th American public health association annual meeting and exposition, Washington, DC.Google Scholar
  29. Nemoto, T., Operario, D., Keatley, J., Han, L., & Soma, T. (2004). HIV risk behaviors among male-to-female transgender persons of color in San Francisco. American Journal of Public Health, 94(7), 1193–1199.CrossRefGoogle Scholar
  30. Nemoto, T., Operario, D., Keatley, J., Nguyen, H., & Sugano, E. (2005). Promoting health for transgender women: Transgender Resources and Neighborhood Space (TRANS) program in San Francisco. American Journal of Public Health, 95(3), 382–384.CrossRefGoogle Scholar
  31. Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2014). Gender abuse, depressive symptoms, and substance use among transgender women: A 3-year prospective study. American Journal of Public Health, 104(11), 2199–2206.CrossRefGoogle Scholar
  32. Operario, D., & Nemoto, T. (2010). HIV in transgender communities: Syndemic dynamics and a need for multicomponent interventions. Journal of Acquired Immune Deficiency Syndromes (1999), 55(Suppl 2), S91. doi: https://doi.org/10.1097/QAI.0b013e3181fbc9ec, S93.CrossRefGoogle Scholar
  33. Operario, D., Nemoto, T., Iwamoto, M., & Moore, T. (2011). Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women. AIDS and Behavior, 15(3), 674–682.CrossRefGoogle Scholar
  34. Operario, D., Soma, T., & Underhill, K. (2008). Sex work and HIV status among transgender women: Systematic review and meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes, 48(1), 97–103.CrossRefGoogle Scholar
  35. Parsons, J. T., Antebi-Gruszka, N., Millar, B. M., Cain, D., & Gurung, S. (2018). Syndemic conditions, HIV transmission risk behavior, and transactional sex among transgender women. AIDS and Behavior, 1–12.Google Scholar
  36. Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102(1), 156–162.CrossRefGoogle Scholar
  37. Parsons, J. T., Millar, B. M., Moody, R. L., Starks, T. J., Rendina, H. J., & Grov, C. (2017). Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a US national sample. Health Psychology, 36(7), 695–703.CrossRefGoogle Scholar
  38. Poteat, T., Wirtz, A. L., Radix, A., Borquez, A., Silva-Santisteban, A., Deutsch, M. B., & Operario, D. (2015). HIV risk and preventive interventions in transgender women sex workers. The Lancet, 385(9964), 274–286.CrossRefGoogle Scholar
  39. Raiford, J. L., Hall, G. J., Taylor, R. D., Bimbi, D. S., & Parsons, J. T. (2016). The role of structural barriers in risky sexual behavior, victimization and readiness to change HIV/STI-related risk behavior among transgender women. AIDS and Behavior, 20(10), 2212–2221.CrossRefGoogle Scholar
  40. Reback, C. J. (2005). Behavioral risk assessment [Unpublished Instrument]. Los Angeles, CA: Friends Research Institute, Inc..Google Scholar
  41. Reback, C. J., & Fletcher, J. B. (2014). HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS and Behavior, 18(7), 1359–1367.  https://doi.org/10.1007/s10461-013-0657-z.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Reback, C. J., & Fletcher, J. B. (2017). Outcomes from a homegrown HIV prevention program for extremely high-risk, substance-using men who have sex with men with multiple health disparities. Journal of gay & lesbian social services, 29(2), 167–181.CrossRefGoogle Scholar
  43. Reback, C. J., Shoptaw, S., & Downing, M. J. (2012). Prevention case management improves socioeconomic standing and reduces symptoms of psychological and emotional distress among transgender women. AIDS Care, 24(9), 1136–1144.  https://doi.org/10.1080/09540121.2012.687817.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Rhodes, S. D., Alonzo, J., Mann, L., Freeman, A., Sun, C. J., Garcia, M., & Painter, T. M. (2015). Enhancement of a locally developed HIV prevention intervention for Hispanic/Latino MSM: A partnership of community-based organizations, a university, and the centers for disease control and prevention. AIDS Education and Prevention, 27(4), 312–332.CrossRefGoogle Scholar
  45. Robinson, B. E., Bockting, W. O., Simon Rosser, B., Miner, M., & Coleman, E. (2002). The sexual health model: Application of a sexological approach to HIV prevention. Health Education Research, 17(1), 43–57.CrossRefGoogle Scholar
  46. Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175–183.CrossRefGoogle Scholar
  47. Sausa, L. A., Keatley, J., & Operario, D. (2007). Perceived risks and benefits of sex work among transgender women of color in San Francisco. Archives of Sexual Behavior, 36(6), 768–777.  https://doi.org/10.1007/s10508-007-9210-3.CrossRefPubMedGoogle Scholar
  48. Schlenker, B. R. (2012). Self-presentation. In M. R. Leary & J. P. Tangey (Eds.). Handbook of self and identity (pp. 541–570).Google Scholar
  49. Shumaker, S. A., & Brownell, A. (1984). Toward a theory of social support: Closing conceptual gaps. Journal of Social Issues, 40(4), 11–36.CrossRefGoogle Scholar
  50. Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17(4), 423–441.CrossRefGoogle Scholar
  51. Spicer, S. S. (2010). Healthcare needs of the transgender homeless population. Journal of Gay & Lesbian Mental Health, 14(4), 320–339.CrossRefGoogle Scholar
  52. Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., & Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6), 939–942.CrossRefGoogle Scholar
  53. Stotzer, R. L. (2009). Violence against transgender people: A review of United States data. Aggression and Violent Behavior, 14(3), 170–179.CrossRefGoogle Scholar
  54. Sugano, E., Nemoto, T., & Operario, D. (2006). The impact of exposure to transphobia on HIV risk behavior in a sample of transgendered women of color in San Francisco. AIDS and Behavior, 10(2), 217–225.  https://doi.org/10.1007/s10461-005-9040-z.CrossRefPubMedGoogle Scholar
  55. Taylor, R. D., Bimbi, D. S., Joseph, H. A., Margolis, A. D., & Parsons, J. T. (2011). Girlfriends: Evaluation of an HIV-risk reduction intervention for adult transgender women. AIDS Education and Prevention, 23(5), 469–478.CrossRefGoogle Scholar
  56. Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology, 54(4), 416–423.CrossRefGoogle Scholar
  57. Vega, M. Y., Spieldenner, A. R., DeLeon, D., Nieto, B. X., & Stroman, C. A. (2010). SOMOS: Evaluation of an HIV prevention intervention for Latino gay men. Health Education Research, 26(3), 407–418.CrossRefGoogle Scholar
  58. White Hughto, J. M., Murchison, G. R., Clark, K., Pachankis, J. E., & Reisner, S. L. (2016). Geographic and individual differences in healthcare access for US transgender adults: A multilevel analysis. LGBT health, 3(6), 424–433.CrossRefGoogle Scholar
  59. White Hughto, J. M., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222–231.CrossRefGoogle Scholar
  60. Wilson, E., Garofalo, R., Harris, R. D., Herrick, A., Martinez, M., Martinez, J., . Interventions, A. M. T. N. f. H. A. (2009). Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS and Behavior, 13(5), 902–913. doi: https://doi.org/10.1007/s10461-008-9508-8.CrossRefGoogle Scholar
  61. Xavier, J. M., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8(2–3), 31–47.  https://doi.org/10.1300/J485v08n02_04.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Friends Research Institute, Inc.Los AngelesUSA
  2. 2.Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human BehaviorUniversity of CaliforniaLos AngelesUSA
  3. 3.Center for HIV Identification, Prevention and Treatment ServicesUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Epidemiology, Fielding School of Public HealthUniversity of CaliforniaLos AngelesUSA

Personalised recommendations