HIV Behavioral Surveillance among Black and Latina Transgender Women in Los Angeles County

Background: HIV prevalence is high among male-to-female transgender women. Limited HIV/AIDS surveillance data exist to help target HIV prevention services for this at-risk population. Sampling methods for recruiting transgender women for research has been under-investigated. Given transgender women's high HIV prevalence and need for HIV services, we conducted a pilot study to assess HIV risks and to test recruitment methods. Methods: Los Angeles County (LAC) participated in the Transgender HIV Behavioral Surveillance (THBS) pilot study in 2008-2009. The THBS objectives were to pilot-test a standardized questionnaire and respondent-driven sampling (RDS) to enroll 100 Black or Latina transgender women. Participants completed questionnaires using audio computer assisted self-interviews (ACASI). Questionnaire items expanded on National HIV Behavioral Surveillance questions to better assess HIV risks among transgender women. Results: Between February and April 2009, we enrolled 103 Black (44%) and Latina (56%) transgender women. 49% of the sample was homeless, 40% were unemployed, 27% were disabled, 13% reported full-time work, and 10% worked part-time. 35%, 25%, and 25% reported unprotected sex with their main, casual, and last male partners, respectively. Self-reported HIV prevalence was 27%; 25% reported unknown HIV status. Conclusion: Although it is unlikely that we recruited a population-based sample of transgender women, we met our target sample size of 100 using RDS. We found that while RDS recruitment largely relies on participants' success in referring social network members, interview location was crucial to participation. Without a Spanish version of the survey, we found that Latinas had limited opportunities to participate in THBS.