Conducting an HIV behavioral survey among transgender persons: Lessons learned from a multi-city pilot

Issues: Male-to-female transgender persons (MtF) are vulnerable to HIV infection and have unique risk behaviors, yet little data exist to understand these behaviors. A behavioral survey designed to capture risk behaviors and prevention experiences could provide these data, but few multi-city surveys have been conducted.

Description: In 2009, CDC conducted a 3-month pilot to determine the feasibility of conducting an HIV behavioral survey in multiple cities. Before the pilot, CDC reviewed the literature, consulted with experts, and tested questionnaire items. The pilot was completed among African American and Latino MtF in Chicago, Houston, and Los Angeles. Persons were screened for eligibility through a face-to-face interview; eligible participants completed an ACASI survey designed to capture HIV-related risk behaviors and prevention experiences. Participants recruited other MtF from their social network using respondent-driven sampling (RDS). The pilot goal was for each city to interview 100 MtF. Overall, 227 eligible MtF were interviewed.

Lessons Learned: Conducting formative work in the local transgender community would have helped improve MtF recruitment. Because recruitment yielded more HIV-positive participants than expected, inclusion of questions to capture clinical outcomes for improving HIV treatment in this population would have been useful.

Recommendations: The pilot demonstrated feasibility for conducting an HIV behavioral survey among MtF in multiple cities. With some adjustments, the methods can be used for a larger scale survey.