Housing as a structural intervention for transgender and gender non-conforming PLWHA: Promoting positive health behaviors

Significance: Due to a complex risk environment, transgender people (TG) have high rates of both homelessness and HIV infection (Operario & Nemoto, 2010). Previous research has examined reasons for high rates of homelessness (Mottet & Ohle, 2003) and HIV (Garafolo et al., 2006) in transgender populations, however, no study to the author's knowledge has examined housing as a structural intervention for transgender people living with HIV/AIDS (PLWHA) or the mechanisms through which stable housing influences risk behaviors and health choices. Methods: 30 semi-structured interviews were conducted with residents in a low-threshold, use-tolerant, scatter-site transitional housing program that is specifically tailored to support previously homeless or unstably housed TG and gender non-conforming (GNC) PLWHA. Participants were asked about their housing and HIV health experiences. Thematic analysis was employed. Results: Housing's effect on health behaviors is mediated by positive material and subjective changes (Fishbein & Azjen, 1975) in the lives of TG and GNC PLWHA. Housing's materiality effect is produced by: a) Reducing exposure to risk environment b) Reducing chaos in living situation c) Access to trans-competent services. Subjective changes were realized through the development of a supportive TG and GNC community which fostered positive health choices by a) changing attitudes about HIV health among program participants b) establishing health-seeking collective norms, and c) improving health related self-efficacy. Conclusions: Housing specifically tailored to the needs of people of TG and GNC experience should be conceptualized as an effective treatment for homeless transgender people living with HIV/AIDS.