Reducing HIV Health Disparities among African American Transgender Women: An mHealth Approach to Improving Prevention, Testing, and Treatment Outcomes

项目摘要/摘要 在美国，五分之一的变性女性(TGW)感染了艾滋病毒。负担尤其繁重。 对非裔美国人来说。虽然16%的美国TGW是黑人，但2009-2014年TGW的所有新病例中有一半以上是黑人 都是非裔美国人。此外，非裔美国人TGW经历了复杂的种族主义互动， 性别歧视和跨性别恐惧症，导致与艾滋病毒相关的所有结果的健康差距。 尽管非裔美国人TGW显然需要有效的艾滋病毒资源，但没有疾控中心定义的证据- 存在针对这一群体的干预措施(EBI)。我们打算通过Shine来满足这一需求，Shine是一家文化定制的 针对黑人TGW的理论驱动的移动干预。信息-动机-行为技能(IMB) 该模型将指导针对用户艾滋病毒状态量身定做的行为改变信息的开发。超越 信息、动机和技能，独特的社会文化背景也影响着TGW的表演能力 与艾滋病毒相关的行为。为了说明这一点，我们将通过解决基于IMB的HIV内容的上下文 黑人TGW的关键精神需求：性别肯定。根据性别肯定模式，a 性别认同确认的需要经常导致TGW从事与艾滋病毒预防相反的行为 和治疗目标。为了进一步改善艾滋病毒的结果，Shine将减少由以下因素造成的艾滋病毒行为障碍 性别肯定需要并赋予黑人TGW以更健康的方式确认其性别的能力。 Share将是对非裔美国人TGW的第一次移动干预，这是基于理论的、个人的- 量身定做，给人以力量。所有用户都将获得与艾滋病毒相关的信息、激励和技能培养 短信。其他信息将提供获得性别肯定的战略。这些短信 将补充三种类型的基于网络的视频：脚本化的小插曲，无脚本化的同行叙事，以及 教育指导。指向这些视频的链接将被集成到消息中，并将增强交易 在我们的IMB框架内对性别肯定的具体理解。一种创新的基于理论的艾滋病毒 旨在克服非裔美国人TGW面临的独特障碍的行为干预； 解决整个艾滋病毒护理连续体系中的要素；以一种授权、教育、 并吸引被污名化的人群；这依赖于一种作为塔吉特日常生活一部分的技术 终端用户有很大潜力有效地减少艾滋病毒差距。 第一阶段的结果有力地支持了该计划的可行性和潜在有效性--FAR 超过第一阶段提案中确定的可用性基准。在第二阶段，我们将完成 SHAINE的发展及其在215名非裔美国人随机对照试验中的有效性 TGW。参与者将被随机分配接受Shine或流动艾滋病毒教育材料。 随机分配参与者在艾滋病毒传播的综合风险前和6个月后 将对预防和治疗行为、这些行为的障碍以及性别肯定需求进行评估。

PROJECT SUMMARY/ABSTRACT One in five transgender women (TGW) in the U.S. is infected with HIV. The burden is particularly onerous for African Americans. While 16% of U.S. TGW are Black, over half of all new cases in TGW from 2009-2014 were among African Americans. Further, African American TGW experience a complex interaction of racism, sexism, and transphobia that leads to health disparities across the entire spectrum of HIV-related outcomes. Despite the clear need for effective HIV resources for African American TGW, no CDC-defined evidence- based interventions (EBIs) exist for this group. We intend to meet this need with Shine, a culturally-tailored, theoretically-driven mobile intervention for Black TGW. The Information-Motivation-Behavioral Skills (IMB) model will guide the development of behavior change messages tailored to a user’s HIV status. Beyond information, motivation, and skills, a unique socio-cultural context also influences TGW’s ability to perform HIV-related behaviors. To account for this, we will contextualize the IMB-based HIV content by addressing a key intrapsychic need among Black TGW: gender affirmation. According to the Model of Gender Affirmation, a need for gender identity validation often leads TGW to engage in behaviors that are counter to HIV prevention and treatment goals. To further improve HIV outcomes, Shine will reduce barriers to HIV behaviors caused by gender affirmation needs and empower Black TGW to affirm their gender in healthier ways. Shine will be the first mobile intervention for African American TGW that is theory-based, individually- tailored, and empowering. All users will receive HIV-related informational, motivational, and skill-building text messages. Additional messaging will provide strategies for gaining gender affirmation. These text messages will be supplemented by three types of web-based videos: scripted vignettes, unscripted peer narratives, and educational instruction. Links to these videos will be integrated into the messaging and will enhance the trans- specific understanding of gender affirmation within our IMB framework. An innovative theory-based HIV behavioral intervention designed to overcome the unique barriers facing African American TGW; that addresses elements across the entire HIV care continuum; that is delivered in a way that empowers, educates, and engages a stigmatized population; and that relies on a technology that is part of the everyday lives of target end-users has the significant potential to meaningfully reduce HIV disparities. The results of Phase I strongly support the feasibility and potential effectiveness of the program – far exceeding the usability benchmarks established in the Phase I proposal. In Phase II, we will complete development of Shine and test its effectiveness in a randomized controlled trial with 215 African American TGW. Participants will be randomly assigned to receive either Shine or mobile HIV education materials. Before and 6 months after random assignment participants’ composite risk for HIV transmission, HIV preventive and treatment behaviors, barriers to those behaviors, and gender affirmation needs will be assessed.