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

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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.

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References

  • Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248–287.

    Google Scholar 

  • Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52(1), 1–26.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Ellemers, N. (1993). The influence of socio-structural variables on identity management strategies. European Review of Social Psychology, 4(1), 27–57.

    Google Scholar 

  • 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 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

  • 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.

    Google Scholar 

  • Kenagy, G. P. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work, 30(1), 19–26.

    Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Reback, C. J. (2005). Behavioral risk assessment [Unpublished Instrument]. Los Angeles, CA: Friends Research Institute, Inc..

    Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Schlenker, B. R. (2012). Self-presentation. In M. R. Leary & J. P. Tangey (Eds.). Handbook of self and identity (pp. 541–570).

  • Shumaker, S. A., & Brownell, A. (1984). Toward a theory of social support: Closing conceptual gaps. Journal of Social Issues, 40(4), 11–36.

    Google Scholar 

  • Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17(4), 423–441.

    PubMed  Google Scholar 

  • Spicer, S. S. (2010). Healthcare needs of the transgender homeless population. Journal of Gay & Lesbian Mental Health, 14(4), 320–339.

    Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • Stotzer, R. L. (2009). Violence against transgender people: A review of United States data. Aggression and Violent Behavior, 14(3), 170–179.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology, 54(4), 416–423.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

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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.

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Authors and Affiliations

  1. Friends Research Institute, Inc., 1419 La Brea Ave, Los Angeles, CA, 90028, USA

    Cathy J. Reback & Jesse B. Fletcher

  2. Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA

    Cathy J. Reback

  3. Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, USA

    Cathy J. Reback

  4. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA

    Kirsty Clark

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  1. Cathy J. Reback
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Correspondence to Cathy J. Reback.

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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.

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Reback, C.J., Clark, K. & Fletcher, J.B. TransAction: A Homegrown, Theory-Based, HIV Risk Reduction Intervention for Transgender Women Experiencing Multiple Health Disparities. Sex Res Soc Policy 16, 408–418 (2019). https://doi.org/10.1007/s13178-018-0356-7

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