Harnessing the power of technology to develop a population-based HIV prevention program for trans girls

据估计，五分之一的变性女孩可能是艾滋病毒阳性。 尽管存在差距，但几乎完全没有性别包容的健康性行为方案，这是震耳欲聋的。解决 由于缺乏性别包容的艾滋病毒预防方案，我们建议制定和测试 #超越健康。内容将侧重于为女孩提供一整套减少风险的战略，包括 经常进行艾滋病毒/性传播感染检测并启动PrEP，以便他们能够选择最适合他们的方案。消息传递 将是性别肯定，同时增加一个人的艾滋病毒预防信息，动机和行为技能。 内容将培养女孩对性别认同的自豪感，并减少她们可能正在经历的内化的变性恐惧症。 我们将利用短信在青年中的覆盖面和广泛采用，提供干预内容。 这种全国性的影响将增加它的普遍性和翻译特性。 作为对RFA-OD-19-029的回应，本提案涉及NIMH的高优先级研究领域： 为改善变性人艾滋病毒预防和治疗结果而进行的干预研究， 重点关注性和性别的影响（战略目标1.3）。具体而言，我们的目标是： 具体目标1：探索性和性别的交叉性如何影响性决定 14-18岁变性女孩的制作（n=80）。很少有人知道transgirls如何决定何时和与 与谁发生性关系，以及他们如何在性别背景下理解自己的性别 影响他们的性决定为了探讨这些问题，我们将进行在线焦点小组讨论。 具体目标2：反复制定#TranscendentHealth，这是一项性别包容的艾滋病毒预防措施 跨性别女孩的计划，与跨性别女孩的持续投入（n=35）。我们将整合从重点 根据14-18岁的跨性别女孩的生活经历进行定制。以确保 消息传递是肯定和可接受的，然后我们将进行内容咨询小组（CAT）， 进行beta测试以确认方案。 具体目标3：用14-18岁的跨性别女孩测试#TranscendentHealth艾滋病预防计划 在美国的年龄（n=200）。我们的主要成果指标将是可行性和 可接受性行为结果将是探索性的，包括艾滋病毒预防连续性41：1） 可接受性，2）动机，和3）吸收PrEP，如果临床指征;和3）艾滋病毒/性传播感染检测和 3个月随访时收到结果。还将探索照片验证测试。 具体目标4：了解性和性别的交叉性如何影响干预措施 体验.我们将检查正在接受性别确认激素治疗的变性女孩是否有 内化的跨性别恐惧症，不同的性别身份体验的干预不同于其他 性别少数青少年

Estimates suggest that one in five transgender girls may be HIV positive In the face of this health disparity, the near-complete absence of gender-inclusive healthy sexuality programs is deafening. To address the lack of gender inclusive HIV prevention programming, we propose to develop and test #TranscendentHealth. Content will focus on providing girls with a panoply of risk reduction strategies, including frequent HIV/STI testing and initiating PrEP, so that they can choose options that fit best for them. Messaging will be gender affirming while increasing one’s HIV preventive information, motivation, and behavioral skills. Content will foster pride in girls’ gender identity and reduce internalized transphobia they may be experiencing. We will harness the reach and wide adoption of text messaging among youth to deliver intervention content. This national reach will increase its generalizability and translational properties. In response to RFA-OD-19-029, this proposal addresses NIMH’s high priority area of research: Intervention research to improve HIV prevention and treatment outcomes for transgender individuals that focuses on the influences of sex and gender (Strategic Goal 1.3). Specifically, we aim to: Specific Aim 1: Explore how the intersectionality of sex and gender inform the sexual decision making of transgirls 14-18 years of age (n=80). Little is known about how transgirls decide when and with whom to have sex or not, as well as how their understanding of their gender within the context of their sex influences their sexual decision-making. To explore these issues, we will conduct online focus groups. Specific Aim 2: Iteratively develop #TranscendentHealth, a gender inclusive HIV prevention program for transgirls, with ongoing input from transgirls (n=35). We will integrate findings from the focus groups into content tailored to the lived experiences of transgirls 14-18 years of age. To ensure that the messaging is affirming and acceptable, we then will conduct Content Advisory Teams (CATs), and then t a beta test to confirm the protocol. Specific Aim 3: Test the #TranscendentHealth HIV prevention program with transgirls 14-18 years of age across the United States (n=200). Our main outcome measures will be feasibility and acceptability. Behavioral outcomes will be exploratory and include those on the HIV prevention continuum41: 1) acceptability of, 2) motivation for, and 3) uptake of PrEP, if clinically indicated; and 3) HIV/STI testing and receipt of results at 3-month follow-up. Photo-verified testing also will be explored. Specific Aim 4: Understand how the intersectionality of sex and gender impact the intervention experience. We will examine whether transgirls who are undergoing gender affirming hormone therapy, have internalized transphobia, and different gender identities experience the intervention differently than other gender minority teens.