Abstract
Purpose: Transgender women experience significant health disparities, including increased risk of HIV infection. In this study, we examined the sexual health needs of transgender women in the context of their overall health and well-being and to identify overarching content framing strategies and content for a mobile health intervention.Methods: We conducted four focus groups and 20 individual in-depth interviews in the United States with racially and geographically diverse transgender women.Results: Four key themes were identified: structural factors as a central part of health; prioritization of transition-related care and mental health; the need for sexual health beyond preventing sexually transmitted infections and HIV; and the importance of connection and community.Conclusions: These themes can help inform the development of HIV prevention and sexual health promotion interventions for transgender women. The results suggest that the HIV and sexual health needs of transgender women should be addressed within the context of structural factors with a focus on resilience, community connection, and social support.
Highlights
IntroductionTransgender populations face considerable health disadvantages, ranging from poorer mental health to barriers to care.[1,2,3] Transgender persons have the highest HIV incidence of any subgroup[4]; transgender women in particular experience significant disparities in HIV infection.[5,6]A growing body of literature has described the links between high HIV rates and the structural contexts of transgender lives, including gender abuse, stigma, transphobia, culturally insensitive health care and health care barriers, and employment and housing discrimination.[7,8,9,10,11,12,13] Other prevalent health conditions among transgender women can contribute to an increase in sexual health risk, including discriminationbased physical and verbal abuse, homicide, poor mental health, alcohol and drug use, and other unmet health needs resulting from limited health care access and negative health care encounters.[1,2,14,15,16,17,18,19] Thus, there is a need for prevention activities that address the social and structural factors contributing to high HIV incidence rates among transgender women.[11,20,21,22,23] In addition, the multiplicity of contextual factors influencing the sexual behavior of transgender women highlights the need to address areas of sexual health beyond HIV and other sexually transmitted infections (STIs)
We identified four main themes related to the health of transgender women
Employment and other structural factors are central to transgender women’s well-being and health Participants focused on the centrality of structural factors in supporting healthy lives
Summary
Transgender populations face considerable health disadvantages, ranging from poorer mental health to barriers to care.[1,2,3] Transgender persons have the highest HIV incidence of any subgroup[4]; transgender women in particular experience significant disparities in HIV infection.[5,6]A growing body of literature has described the links between high HIV rates and the structural contexts of transgender lives, including gender abuse, stigma, transphobia, culturally insensitive health care and health care barriers, and employment and housing discrimination.[7,8,9,10,11,12,13] Other prevalent health conditions among transgender women can contribute to an increase in sexual health risk, including discriminationbased physical and verbal abuse, homicide, poor mental health, alcohol and drug use, and other unmet health needs resulting from limited health care access and negative health care encounters.[1,2,14,15,16,17,18,19] Thus, there is a need for prevention activities that address the social and structural factors contributing to high HIV incidence rates among transgender women.[11,20,21,22,23] In addition, the multiplicity of contextual factors influencing the sexual behavior of transgender women highlights the need to address areas of sexual health beyond HIV and other sexually transmitted infections (STIs)
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