Incentivizing medically supervised hormone therapy: A peer driven HIV prevention intervention with African American transgender women

Background: In Virginia, 16% of African American transgender women (AATGW) are HIV positive. Compounding behavioral risk factors (e.g. sex work; inconsistent condom use) increase risk of HIV. AATGW utilize ‘street' hormone therapy to improve their desirability. In April 2008, ACCESS began implementation of a four year peer-driven community-level intervention to provide HIV prevention to AATGW. Collaborating with a local health center, a Transgender Clinic was created. Utilizing Community Promise, a CDC DEBI community-level intervention, peer advocates share role model stories within their communities. Free medical supervision of hormone therapy and medical screenings are incentives to encourage utilization of HIV/STI prevention services.

Methods: Formative research consisted of 3 focus groups, anonymous questionnaires, key informant interviews. Peer advocates exhibiting HIV risk reduction behaviors were selected through key informant interviews. Survey instruments capture baseline and continuous data from health screenings, program intake, participant self esteem, clinic service satisfaction. A dependent t-test compared participant's self-esteem from baseline to 3-months with re-assessment at 3-month intervals.

Findings: 107 individuals have enrolled at clinic—79 MTF transgender (28 FTM). 3-month follow-up, participants experience significantly higher self-esteem(p<0.011). 95% clinic satisfaction surveys indicate individuals would recommend clinic to others in transgender community.

Conclusion: To date, noteworthy findings have occurred. Culturally competent clinic services meet the gap of this population. Medically supervised hormone therapy incentive is effective in bringing target population into health clinic setting. Peer advocates and role model intervention components have initiated community support and serve as a catalyst to social networks.