U.S. transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability: a qualitative assessment

BMC Public Health

Brittanni N. Wright¹  Larissa Jennings Mayo-Wilson²  Lauretta Cathers³  Ashlee N. Sawyer³  Eric G. Benotsch³  Shelby A. Smout³  Nastacia Pereira⁴  Tonia Poteat⁴  Sheila R. Grigsby⁵  Rick S. Zimmerman⁶ 

[1] Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, 47405, Bloomington, IN, USA;Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, 47405, Bloomington, IN, USA;Global & Public Health Division, Johns Hopkins University School of Nursing, Community, 525 N. Wolfe Street, 21205, Baltimore, MD, USA;Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, 23284, Richmond, VA, USA;Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, 27516, Chapel Hill, NC, USA;University of Missouri St. Louis, College of Nursing, 221 NAB South Campus, University Blvd, 63121, St. Loius, MO, USA;Wayne State University, College of Nursing, 5557 Cass Avenue, 48202, Detroit, MI, USA;

关键词: Transgender women;    Housing;    Structural;    Intervention development;    Employment;    Economic;    Qualitative;    U.S.;    HIV;    Gender;    Minority;   

DOI  :  10.1186/s12889-021-11471-8

来源: Springer

【 摘 要 】

BackgroundTransgender women in the United States (U.S.) experience a disproportionate burden of HIV infection and challenges to engagement in HIV prevention and care. This excess burden is driven by structural and economic inequities. Microeconomic interventions may be effective strategies for reducing HIV inequities for this population. However, few studies have explored transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability.MethodsWe conducted individual interviews with 19 adult transgender women in 2 U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis.ResultsThe majority (74%) of transgender women were racial/ethnic minorities with mean age of 26.3 years. 89% were currently economically vulnerable; and 23% were employed full-time. 37% reported living with HIV. Participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. Assistance with how to budget and save and support for job acquisition, career planning, and employment sustainment were also preferred, including access to non-stigmatizing employment. Visible transgender leadership, group empowerment, and small (rather than large) numbers of participants were considered important aspects of intervention design for transgender women, including outreach through existing transgender networks to facilitate inclusion. Incorporating HIV counseling and testing to reduce vulnerability to HIV was acceptable. However, transgender women enrolled in the study preferred that HIV not be the focus of an intervention.ConclusionsFlexible microeconomic interventions that support gender affirming interventions, improve financial literacy, and provide living-wage non-stigmatizing employment are desired by economically vulnerable transgender women. While not focused on HIV, such interventions have the potential to reduce the structural drivers of HIV vulnerability among transgender women.

【 授权许可】

CC BY