Background : Despite the exceptionally high HIV infection rates and unique risk factors and prevention needs, there are few evidence-based HIV prevention interventions designed specifically for transgender women. We conducted formative research to guide the development of a mobile health app to support HIV prevention among transgender women.
Methods : We conducted four focus groups and 21 semi-structured interviews with transgender women and providers across the U.S. The focus group and interview guide covered three main domains: well-being and connectedness, transgender health, and use of internet and social media. Thematic analysis using a data-driven inductive approach and constructivist paradigm was conducting, using Dedoose software to organize data and data analyses.
Results : HIV was not identified as a primary health concern for many women. Instead, the most common health concerns described were structural barriers to accessing care (e.g. housing and employment) and a lack of affirming and knowledgeable providers. Women also prioritized transition-related care and mental health care (related to both gender identity and other mental health needs).
Both structural barriers and lack of affirming services were important concerns when it came to HIV prevention and care. Gender affirmation and desire for romantic relationships were described as important factors contributing to behaviors that increased the risk of acquiring HIV.
Although HIV and STDs were the most common topics mentioned when discussing sexual health, participants also highlighted the need for sexual health services to address other components of sexual health for transgender women. Women felt that they lacked comprehensive sexual education and expressed the need for sexual health education that focused on pleasure as well as on risk.
Conclusions : HIV prevention for transgender women must take into account the role of structural factors. A focus solely on HIV will fail to address the health concerns that matter most to transgender women.