Background : Transgender people face stigma and discrimination in all aspects of society, including in medical and research settings. The cumulative traumatic experiences often result in an unwillingness to seek care, let alone participate in research. Given the disproportionate impact of HIV in transgender communities, especially among transgender women of color, a critical need exists to increase transgender inclusion in HIV prevention and treatment research.
Methods : The NIAID Division of AIDS (DAIDS) Cross-Network Transgender Working Group recognized the need to increase staff understanding of and responsiveness to transgender participants and sought to develop a curriculum relevant to HIV research settings. Subject matter experts, including transgender and gender non-conforming people, advocates, and researchers, were identified to work with staff from DAIDS, the Office of HIV/AIDS Network Coordination, and NIAID’s HIV/AIDS clinical trials networks. The resulting training modules address five content areas; each module was piloted before being developed further. The modules include: 1) An Introduction to Transgender Communities; 2) Creating a Gender-Affirming HIV Research Environment; 3) HIV in Transgender Communities; 4) Clinical Considerations and HIV Risk Assessments for Transgender Research Participants; and 5) Trauma-Informed Care for Transgender Research Participants. Each consists of a PowerPoint presentation, facilitator’s guide, exercises, a handout of resources and publications, and a Web-based training tool to support broad dissemination. The first module – An Introduction to Transgender Communities – is required, as it forms a foundation for understanding the remaining content.
Results : There was a great deal of support for the development of this curriculum, and the modules have been well-received. Each of the in-person pilot training sessions garnered strong interest both within and outside the NIAID-funded networks. Participants have included community advisory board members, clinicians, community educators/recruiters, data managers, study coordinators, laboratory and regulatory staff, as well as DAIDS staff. While the training modules have a strong U.S. focus, the content can be modified for global applicability and international participants have noted the potential value of the training for their sites.
Conclusions : The process of developing the content with ongoing review and input by a transgender-inclusive and diverse group of subject matter experts was critical to the success of each module. The input helped ensure the accuracy, sensitivity, and cultural responsiveness espoused in the curriculum itself. Also, having transgender facilitators at each in-person training was important and recommended when possible. The first module has already been developed into a web-based learning tool and the development of the other modules continue. The goal is to reduce the lack of information that perpetuates misgendering, stigma, mistreatment, and trauma often experienced by transgender people in health care settings. Cultivating awareness, knowledge and understanding of transgender communities is a vital step in providing transgender-responsive HIV care and services, and in supporting transgender inclusion in all aspects of HIV research.