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

据估计，面对这种健康状况，五分之一的变性女孩可能是艾滋病毒阳性。 尽管性别差异很大，但几乎完全没有包含性别因素的健康性行为计划令人震耳欲聋。致信地址 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 频繁的艾滋病毒/性传播感染检测和启动PrEP，以便他们可以选择最适合自己的方案。传讯 将是性别肯定，同时增加一个人的艾滋病毒预防知识、动机和行为技能。 内容将培养女孩对性别认同的自豪感，并减少她们可能经历的内在性易性恐惧症。 我们将利用短信在年轻人中的普及和广泛采用来提供干预内容。 这一全国性的覆盖范围将增加其通用性和可翻译性。 作为对RFA-OD-19-029的回应，本提案涉及NIMH的高度优先研究领域： 旨在改善变性人艾滋病毒预防和治疗结果的干预研究 侧重于性别和性别的影响(战略目标1.3)。具体来说，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岁跨性别女性(n=80)。关于变性人是如何决定何时和与谁在一起的，我们知之甚少 以及在他们的性别背景下，他们对自己性别的理解 会影响他们的性决策。为了探讨这些问题，我们将开展在线焦点小组。 具体目标2：反复制定#TranscendentHealth，一种性别包容的艾滋病毒预防 跨性别女孩方案，由跨性别女孩提供持续投入(n=35)。我们将整合来自焦点的调查结果 根据14-18岁变性女孩的生活经历而定制的内容。以确保 消息是肯定的和可接受的，然后我们将组建内容咨询团队(CATS)，然后测试 贝塔测试以确认协议。 具体目标3：在14-18岁的变性女孩中测试#年先验健康艾滋病毒预防方案 美国各地的年龄(n=200)。我们的主要成果措施将是可行性和 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的结果(41：1) 可接受性，2)动机和3)摄取PrEP，如果临床指征；和3)HIV/STI检测和 在3个月的随访中收到结果。照片验证测试也将被探索。 具体目标4：了解性别和性别的交叉性如何影响干预 经验。我们将检查正在接受性别肯定激素治疗的变性女孩是否有 内在性跨性恐惧症，不同性别认同的干预体验不同于其他 性别少数的青少年。

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.