Investigating resilience in light of HIV risk among transfemale youth

In San Francisco, transgender females, especially youth, are among the highest risk groups for HIV, yet few studies have been conducted with this population. Formative research was conducted using a youth development lens to both better understand HIV risk and identify protective factors that may promote resilience among a diverse set of transfemale youth. Eight focus groups were conducted with 30 transfemale youth, ages 16-24 in the San Francisco Bay Area, in order to inform future research with this population. The focus groups used a semi-structured discussion guide that explored potential protective factors against HIV acquisition, such as social support networks, goals, and self-esteem. A recurring theme from the data was the importance of physical appearance and “passability” when discussing self-esteem. It appeared that the youths' goals, which related to furthering their transition and becoming more passable or more attractive, trumped other goals such as finding a meaningful job, relationship or achieving in school. At the same time, several youth reported that positive feedback on their appearance may not alone prevent low self-esteem. In fact, several youth asserted that the “prettiest” transgender females they knew were the ones who had the lowest self-esteem. These data point to the importance of family support, friendships, jobs other than sex work, safe social spaces, positive transfemale role models, satisfying romantic relationships and individual strength. More research is needed to explore how structural and behavioral risk and protective factors relate to HIV infection among transfemale youth and to determine potentially effective prevention interventions and programs to support this population.