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Red Internet

¿Cómo afecta la red Internet en la prevención del VIH?

¿por qué Internet?

Internet se ha convertido en una herramienta de conexión social que mediante unas pocas tecleadas une a personas que difícilmente se conocerían en el mundo físico. No es sorprendente que muchas personas con acceso a Internet la hayan usado para buscar amor, compañerismo y sexo.1 De hecho, el uso de Internet para buscar parejas sexuales es una práctica amplia entre hombres y mujeres de todas las edades. Unas 16 millones de personas afirman haber visitado páginas web con el fin de conocer a otras personas.2 Los hombres que tienen sexo con hombres (HSH)— una conducta tradicionalmente estigmatizada— se han beneficiado de la privacidad que les ofrece Internet, y un 40 % de los hombres homosexuales informan que usan Internet para conocer a parejas sexuales.3 En entrevistas realizadas en línea, los hombres gay afirmaron que Internet los ha ayudado a encontrar apoyo social, obtener recursos en forma segura y anónima y formar relaciones personales importantes.4 Internet es importante en el campo de la prevención del VIH. Es un medio poderoso para brindar información sobre la salud y la reducción de riesgos. Muchos individuos que participan en conductas de riesgo usan Internet para conocer a sus parejas sexuales, y es posible que Internet en sí facilite tales conductas riesgosas.

¿contribuye Internet al riesgo?

No se entiende completamente si las características únicas de Internet contribuyen a las conductas riesgosas o no. Se ha comprobado que las personas que usan Internet para conocer a parejas sexuales tienen conductas más riesgosas, más probabilidades de reportar antecedentes de ITS y mayores números de parejas sexuales que otras personas que no buscan parejas sexuales en línea.3,5 De hecho, ya desde 1999, se detectaron brotes de sífilis entre HSH mediante rastreo a usuarios de ciertas salas de conversación.6 También existen informes de casos de transmisión del VIH entre parejas sexuales que se conocieron en línea.7 Sin embargo, se ha encontrado que los hombres que participan en conductas de alto riesgo lo hacen independientemente de si conocieron a sus parejas en línea o de otra manera, como en un bar o club.8 Los hombres gay o bisexuales con “vulnerabilidades psicosociales” (p.ej., hartos de practicar el sexo seguro, deprimidos y socialmente aislados) pueden ser especialmente propensos a distanciarse emocionalmente, o a evitar pensar en el VIH, en el anonimato de un mundo virtual que les permite conocer a parejas con el fin de tener sexo de alto riesgo.9 El uso de Internet para conocer a parejas fuera de su red social habitual también puede crear un ambiente en el cual ocurre contacto sexual entre personas de alto riesgo y otras de bajo riesgo.10 Las nuevas redes sexuales expandidas pueden, a su vez, aumentar la frecuencia de transmisión del VIH y otras ITS.

¿puede Internet ayudar en la prevención?

Absolutamente. El anonimato de la comunicación en línea puede facilitar la revelación de la condición de VIH o las conversaciones sobre el sexo más seguro y el uso de condones antes de conocerse personalmente. Un estudio de HSH latinos encontró que eran mucho más propensos a participar en la negociación sexual y de revelar su serocondición en Internet que en persona.11 Para las personas VIH+, la revelación de su condición de VIH en línea también ayuda a evitar el abuso, la discriminación o el rechazo por parte de sus parejas.12 Internet también facilita la búsqueda de parejas sexuales que compartan los mismos gustos y estén dispuestas a correr el mismo nivel de riesgo. Este medio tal vez ofrece más oportunidades para charlar con una pareja potencial antes de tener sexo. En los anuncios en línea, uno puede exponer claramente que busca parejas que acepten practicar el sexo más seguro (como el uso de condones) y es más fácil evitar quienes no concuerden. Asimismo, la búsqueda sexual en línea permite que las personas VIH+ revelen su condición y encuentren parejas de la misma serocondición (a esto muchas veces se le llama seroselección), especialmente si no piensan usar condones.8 Al igual que en el mundo físico, sin embargo, no es posible confiar completamente en que otro le diga o siquiera conozca su condición de VIH exacta, entonces la seroselección tal vez no sea una estrategia infalible de prevención del VIH, y también conlleva el riesgo de transmitir otras ITS.

¿qué se está haciendo al respecto?

Las organizaciones comunitarias (CBOs), los investigadores y los departamentos de salud, a veces con el apoyo de los proveedores de servicios en línea, aprovechan Internet creativamente con el fin de aumentar la conciencia y los conocimientos sobre el VIH y para afectar en forma positiva las actitudes, creencias y conductas. Los investigadores han usado Internet para reclutar a participantes y recopilar datos. También se han usado Internet para ayudar a las personas a revelar en forma anónima su condición de VIH/ITS a sus parejas anteriores. Las CBOs frecuentemente han usado listas de distribución de correo electrónico o han enviado a educadores que visitan sitios populares para charlar en línea (salas de conversación, sitios de ligue, etc.) para promover sus programas, contestar preguntas, informar sobre el sexo protegido y otros temas, y para fomentar el diálogo sobre la prevención del VIH. Unas cuantas CBOs con fondos dedicados a este fin crearon sitios web sobre la prevención del VIH.13 Lanzado en el 2002, PowerOn es un sitio integral que provee acceso a información, apoyo y recomendaciones a servicios relacionados con el VIH/SIDA a 200 organizaciones locales de prevención para la comunidad gay, bisexual y transgénero del condado de Seattle/King, WA. Los primeros usuarios de PowerOn indicaron especial interés en las páginas sobre la negociación de acuerdos de seguridad y para la colocación correcta del condón.14 Wrapp.net brinda intervenciones y recursos de prevención del VIH para HSH en las zonas rurales de EE.UU. Una intervención financiada por los NIMH presentó una conversación entre un hombre VIH+ y otro VIH- quienes acababan de participar en conducta riesgosa. Un ensayo controlado aleatorizado encontró que el sitio tenía buena acogida y que mejoró los conocimientos de los participantes con respecto a la reducción de riesgos del VIH, sus actitudes hacia el sexo más seguro, sus creencias sobre las consecuencias de ciertas conductas y sus creencias sobre su capacidad para efectuar ciertas tareas.15 Una vez creadas, las intervenciones en línea operan en forma económica las 24 horas del día, se pueden modificar fácilmente en el momento necesario y se pueden establecer normas de control de calidad con poca posibilidad de error humano. Personas con acceso a Internet pueden usar estos programas según su conveniencia y con poco riesgo a su intimidad personal. Muchos departamentos de salud exploran las aplicaciones de Internet con respecto a notificación de parejas, ayuda para revelar la serocondición y remisiones a servicios relacionados.16 InSPOT.org, creado por ISIS, Inc., es un sitio web en el cual, en forma conveniente y sin la intervención del proveedor médico, los hombres diagnosticados con VIH/ ITS pueden enviar tarjetas electrónicas a sus parejas sexuales para informarles de la posible exposición. Las tarjetas se pueden enviar en forma anónima, con o sin un mensaje personal. Los propietarios de sitios web populares también pueden participar en la prevención del VIH. Craigslist.org aceptó agregar un mensaje informativo y un enlace al sitio web de la San Francisco City Clinic para usuarios que visiten las páginas sobre “hombres que buscan a hombres” y “encuentros casuales.” Esta añadidura no produjo una disminución en el número de comentarios colocados ni de visitantes. Manhunt aceptó colocar anuncios sobre los peligros del uso de la metanfetamina cristal y sobre el aumento en los casos de sífilis. Gay.com accedió a una petición de integrar mensajes de salud sexual por medio de un enlace con“Ask Dr. K,” un foro de preguntas y respuestas sobre la salud sexual.17

¿qué queda por hacer?

Es preciso crear y evaluar nuevas intervenciones que respondan a los riesgos de VIH vinculados con Internet. Los programas que ayuden a las personas a pensar en sus motivos para buscar parejas en línea y las herramientas de detección y remisión en Internet pueden ser abordajes prometedores. Es crucial realizar más evaluaciones sobre la eficacia de los actuales programas en línea antes de determinar que tales intervenciones sean meritorios de ser reproducidos. También se necesitan políticas sociales para ayudar a evitar la transmisión del VIH facilitada por Internet; tales normas pueden lograrse por medios legislativos o por cambios voluntarios efectuados por los propietarios de sitios web. Las colaboraciones entre los proveedores de servicios en línea, los legisladores, los investigadores, los planificadores de programas y, de mayor importancia, los integrantes de la comunidad, podrían generar cambios estructurales que eviten más transmisiones de VIH facilitadas por Internet.18 Las opciones de cambios normativos abarcan: advertencias de salud pública en los sitios web; cambios en la forma en que se publicitan los sitios de ligue; la promoción de investigaciones que midan los cambios de conducta producidos por las intervenciones en línea y la creación de herramientas en los sitios de ligue y en los sitios para conocer parejas que faciliten las conversaciones sobre el VIH y el sexo más seguro; así como incentivos para los operadores de sitios web para que cooperen con a los esfuerzos de salud pública y de la prevención del VIH.

¿Quién lo dice?

1. Chiasson MA, Parsons JT, Tesoriero JM, et al. HIV behavioral research online.Journal of Urban Health. 2006;83:73-85. 2. Madden M, Lenhart A. Online dating. Report prepared by the Pew Internet and American Life Project. March 2006. 3. Liau A, Millett G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sexually Transmitted Diseases. 2006;33:576-584. 4. Rebchook G, Curotto A, Kegeles S. Exploring the sexual behavior and Internet use of chatroom-using men who have sex with men through qualitative and quantitative research. Presented at the 2003 National HIV Prevention Conference, Atlanta, GA. 5. McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. Journal of the American Medical Association. 2000;284:443-446. 6. Klausner JD, Wolf W, Fischer-Ponce L, et al. Tracing a syphilis outbreak through cyberspace. Journal of the American Medical Association. 2000;284:447-449. 7. Tashima K, Alt E, Harwell J, et al. Internet sex-seeking leads to acute HIV infection: a report of two cases. International Journal of STD and AIDS. 2003;14:285-286. 8. Bolding G, Davis M, Hart G, et al. Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? AIDS. 2005;19:961-968. 9. McKirnan D, Houston E, Tolou-Shams M. Is the Web the culprit? Cognitive escape and Internet sexual risk among gay and bisexual men. AIDS and Behavior. 2006. 10. Wohlfeiler D, Potterat JJ. Using gay men’s sexual networks to reduce sexually transmitted disease (STD)/human immunodeficiency virus (HIV) transmission. Sexually Transmitted Diseases. 2005;32:S48-52. 11. Carballo-Dieguez A, Miner M, Dolezal C, et al. Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men. Archives of Sexual Behavior. 2006;35:473-481. 12. Davis M, Hart G, Bolding G, et al. Sex and the Internet: gay men, risk reduction and serostatus. Culture, Health and Sexuality. 2006;8:161-174. 13. Curotto A, Rebchook G, Kegeles S. Opening a virtual door into a vast real world: Community-based organizations are reaching out to at-risk MSM with creative, online programs. Paper presented at: STD/HIV Prevention and the Internet; August 27, 2003; Washington D.C. 14. Weldon JN. The Internet as a tool for delivering a comprehensive prevention intervention for MSM Internet sex seekers. Paper presented at: 2003 National HIV Prevention Conference; July 27-30, 2003, 2003; Atlanta, GA. depts.washington.edu/poweron/ 15. Bowen AM, Horvath K, Williams ML. A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. Health Education Research. 2006.www.wrapp.net 16. Mimiaga MJ, Tetu A, Novak D, et al. Acceptability and utility of a partner notification system for sexually transmitted infection exposure using an internet-based, partner-seeking website for men who have sex with men. Presented at the International AIDS Conference, Toronto, Canada. 2006. Abstr #THPDC02. 17. Klausner JD, Levine DK, Kent CK. Internet-based site-specific interventions for syphilis prevention among gay and bisexual men. AIDS Care, 2004;16:964-970. 18. Levine D, Klausner JD. Lessons learned from tobacco control: A proposal for public health policy initiatives to reduce the consequences of high-risk sexual behavior among men who have sex with men and use the Internet. Sexuality Research and Social Policy. 2005;2:51-58.
Preparado por Greg Rebchook PhD*, Alberto Curotto PhD* and Deb Levine** *CAPS, **ISIS Traducido por Rocky Schnaath Mayo 2007. Hoja de Dato #63S
Resource

Transgender Women and HIV Prevention and Care

Transgender Women and HIV Prevention and Care

‘Transgender women’ is an umbrella term to refer to persons who identify as women or trans women, or who have a feminine gender identity that differs from the male sex they were assigned at birth. Transgender women may identify with certain terms and not others and may express gender in a variety of ways. Gender identity terms vary by geographic region, race, ethnicity, age, and other factors, so it is best to ask people what they prefer. Best practices for obtaining information on gender identity in the context of research and health services continue to evolve.1

Transgender Women and HIV Risk

Transgender women are at disproportionate risk for HIV; an estimated 19.1% of transgender (‘trans’) women are living with HIV, according to a meta-analysis of studies from around the world.2 Internationally, trans women have 49 times higher odds of living with HIV compared to the general adult population;3 in the US they have the highest rates of new diagnoses by gender.4 Black and Latina trans women experience an extremely high HIV burden; more than half of trans people diagnosed with HIV are Black (44%) or Hispanic/Latinx (26%).5 Intersectional stigma—oppression rooted in racism, transphobia, and misogyny6—fuels structural vulnerabilities among trans women of color7-9 and has been linked with trauma symptoms, inconsistent condom use, suboptimal PrEP and ART adherence, and detectable viral load.10-12 Like many populations, those at greatest risk are more likely to be poor, homeless, young, people of color, and engage in sex work.13,14

Not all trans women are at risk for HIV; however, stigma and discrimination faced by trans women often results in social marginalization, increasing risk of poor health outcomes.15 Social isolation and rejection by family members is common, which can lead to anxiety, depression, experiencing homelessness at a young age, and heightened risk of suicidal ideation and attempts.16,17 School-based stigma and bullying make young trans women vulnerable to dropping out and poor mental health, disrupting education and employment pathways.18-20 Sex work, recent homelessness, and school dropout are associated with incarceration, which trans women experience at higher rates than the general population.21

HIV Prevention and Care for Transgender Women

The provision of gender-affirming HIV prevention and care services is of utmost importance to serving trans women effectively.22 Trans people often report avoiding health care settings due to stigma and past negative experiences; when seeking care, they tend to prioritize gender-affirming medical care, such as hormone therapy, over HIV prevention services such as PrEP.23-25 Barriers to PrEP use among trans women include low PrEP awareness, concerns about drug interactions with hormone therapy, and low access to gender-affirming care.26-28 A 2020 national probability sample of trans people found only 3% of sexually active respondents were currently taking PrEP.29

Efficacious prevention programming prioritizing the needs of trans women has increased in the last decade, although much work remains. The first National Transgender HIV Testing Day was held on April 18, 2016. In 2018, the Health Resources and Services Administration Special Projects of National Significance Division published the Transgender Women of Color Initiative: Project Interventions Manual and then in 2019, the Centers for Disease Control and Prevention published their Toolkit for Providing HIV Prevention Services to Transgender Women of Color. Trans women experience unique barriers to prevention and care, and therefore, trans women should not be subsumed into MSM programming.30 Research consistently demonstrates that programs based in gender affirmation have the greatest impact in optimizing health outcomes for trans women.31-38

Training for healthcare providers in creating inclusive, gender-affirming clinical environments. Quality, affirming healthcare is important for trans women. Despite their sincere concern to serve patients effectively, providers may have very little knowledge, experience, skills and therefore comfort with trans patients though the availability of transgender-specific training for medical students is increasing39. UCSF Transgender Care provides free online resources for healthcare providers and other professionals for guidance on staff training, creating welcoming spaces, and data collection.

HIV Testing and Prevention. Three interventions designed for trans women have demonstrated efficacy with reducing risk and increasing HIV testing. Couples HIV Intervention Program (CHIP) is designed for trans women and their cisgender male partners as an intervention to support the couple and promote HIV testing and safe sex practices. Project Life Skills is a group-based intervention for young trans women focused on communication skills and condom negotiation. Sheroes is an intervention for adult trans women of color comprised of five weekly group sessions emphasizing healthcare empowerment and gender affirmation.40 Facilitating PrEP use among HIV prevention strategies is a developing area in services that prioritize trans women. Recent research provides emerging evidence for a trans-specific advertising campaign promoting PrEP use (PrEP4Love)41 and there is also emerging evidence for a program to increase PrEP adherence using peer navigators (A.S.K.-PrEP).42

Linkage and retention in HIV care. Transgender Women Entry and Engagement to Care Project (TWEET) is a group-based intervention to link transgender women living with HIV to care and support their engagement in care. Transgender Women Involved in Strategies for Transformation (TWIST) is a peer-led, small-group, skills-building, and educational high-impact prevention (HIP) intervention for adult trans women living with HIV. Healthy Divas combines individual sessions with a peer counselor and a group workshop with a medical provider to promote engagement in gender-affirming and HIV medical care.43-45

Unaddressed Needs of Transgender Women

To address the devastating effects of stigma and discrimination on trans people, large-scale anti-stigma campaigns, as well as anti-discrimination laws, should be implemented across the country. Structural interventions such as job training, housing, and educational programs should be widely implemented and evaluated. Ongoing capacity building and sensitivity training should be provided for healthcare workers, school officials, service providers, and researchers working with trans women. More research is needed with sexual partners of trans women, as well as programs that work with trans women and partners together as a couple.46 Finally, more research should be done with trans youth to identify and develop strategies for HIV prevention for young adults identifying as trans and gender diverse.47 Interventions and programs that leverage the inherent resilience and support networks within trans communities are also promising approaches to optimizing health outcomes among trans women.48

Resources

 

Fact Sheet Date Authors
September 2008 / Revised 2015

JoAnne Keatley MSW / CAPS and Pacific AETC

Walter Bockting Ph.D. / University of Minnesota
Revised June 2021

Beth Bourdeau, Ph.D. / Division of Prevention Science

Jae Sevelius, Ph.D. / Division of Prevention Science

Greg Rebchook, Ph.D. / Division of Prevention Science

Jenna Rapues, MPH / San Francisco Department of Public Health

Nasheedah Bynes-Muhammad/ The Journey Partners LLC



 

Says who?

Orientation and Gender Identity Questions: A Qualitative Study. Archives of sexual behavior. 2020;49(7):2301-2318.

2.     Baral S, Poteat T, Stromdahl S, Wirtz A, Guadamuz T, Beyrer C. Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases. 2013;13(3):214-222.

3.     Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet infectious diseases. 2013;13(3):214-222.

4.     Herbst J, Jacobs E, Finlayson T, McKleroy V, Neumann M, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior. 2008;12(1):1-17.

5.     Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV infection in transgender adults and adolescents: results from the National HIV Surveillance System, 2009–2014. AIDS and Behavior. 2017;21(9):2774-2783.

6.     Bailey M, Trudy. On misogynoir: citation, erasure, and plagiarism. Feminist Media Studies. 2018:1-7.

7.     Palazzolo SL, Yamanis TJ, et al. Documentation status a contexual determinent of HIV risk among young transgender Latinas. LGBT Health. 2016;3(2):132-138.

8.     Fletcher JB, Kisler KA, Reback CJ. Housing status and HIVrisk behaviors among transgender women in Los Angeles. Arch Sex Behav 2014;43:1651-1661.

9.     Operario D, Nemoto T. HIV in transgender communities: Syndemic dynamics and a need for multicomponent interventions. J Acquir Immune Defic Syndr. 2010;55:S91-S93.

10.   Richmond KA, Burnes T, Carroll K. Lost in trans-lation: Interpreting systems of trauma for transgender clients. Traumatology. 2012;18(1):45-57.

11.   Smith LR, Yore J, Triplett DP, Urada L, Nemoto T, Raj A. Impact of Sexual Violence Across the Lifespan on HIV Risk Behaviors Among Transgender Women and Cisgender People Living With HIV. J Acquir Immune Defic Syndr. 2017;75(4):408-416.

12.   Wirtz AL, Poteat TC, Malik M, Glass N. Gender-Based Violence Against Transgender People in the United States: A Call for Research and Programming. Trauma Violence Abuse. 2018:1524838018757749.

13.   Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006–2017. American Journal of Public Health. 2019;109(1):e1-e8.

14.   Reback CJ, Clark K, Holloway IW, Fletcher JB. Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998–1999 to 2015–2016. AIDS and behavior. 2018;22(8):2524-2533.

15.   Wesp LM, Malcoe LH, Elliott A, Poteat T. Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities. Transgend Health. 2019;4(1):287-296.

16.   Kota KK, Salazar LF, Culbreth RE, Crosby RA, Jones J. Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BMC public health. 2020;20(1):125-125.

17.   Testa RJ, Michaels MS, Bliss W, Rogers ML, Balsam KF, Joiner T. Suicidal Ideation in Transgender People: Gender Minority Stress and Interpersonal Theory Factors. Journal of abnormal psychology (1965). 2017;126(1):125-136.

18.   Hereth J, Garthe RC, Garofalo R, Reisner SL, Mimiaga MJ, Kuhns LM. Examining Patterns of Interpersonal Violence, Structural and Social Exclusion, Resilience, and Arrest among Young Transgender Women. Criminal justice and behavior. 2021;48(1):54-75.

19.   Leppel K. Transgender Men and Women in 2015: Employed, Unemployed, or Not in the Labor Force. Journal of homosexuality. 2021;68(2):203-229.

20.   Vance SR, Jr., Boyer CB, Glidden DV, Sevelius J. Mental Health and Psychosocial Risk and Protective Factors Among Black and Latinx Transgender Youth Compared With Peers. JAMA Network Open. 2021;4(3):e213256-e213256.

21.   Hughto JMW, Reisner SL, Kershaw TS, et al. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf). 2019;41(1):100-109.

22.   Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. Journal of the International AIDS Society. 2016;19(7Suppl 6):21105.

23.   Braun HM, Candelario J, Hanlon CL, et al. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug–Drug Interaction Concerns. LGBT health. 2017;4(5):371-375.

24.   Reisner SL, Perez-Brumer AG, McLean SA, et al. Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru. AIDS and behavior. 2017;21(12):3299-3311.

25.   Sevelius JM, Keatley J, Calma N, Arnold E. 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Global public health. 2016;11(7-8):1060-1075.

26.   Cahill SR, Keatley J, Wade Taylor S, et al. “Some of us, we don’t know where we’re going to be tomorrow.” Contextual factors affecting PrEP use and adherence among a diverse sample of transgender women in San Francisco. AIDS Care. 2020;32(5):585-593.

27.   Sevelius JM, Keatley J, Calma N, Arnold E. “I am not a man”: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Global Public Health. 2016(Special issue, The Trouble with ‘Categories’: Rethinking MSM, Trans and their Equivalents in HIV Prevention and Health Promotion).

28.   Poteat T, Wirtz A, Malik M, et al. A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019;82(2).

29.   Sevelius JM, Poteat T, Luhur WE, Reisner SL, Meyer IH. HIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States. Journal of acquired immune deficiency syndromes. 2020.

30.   Sevelius JM, Keatley J, Calma N, Arnold E. 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women. 2016.

31.   Lacombe-Duncan A, Newman P, Bauer G, et al. Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: A mixed-methods study. Sexual health. 2019;16(4):367-376.

32.   Lama J, Mayer K, Perez-Brumer A, et al. Integration of gender-affirming primary care and peer navigation with HIV prevention and treatment services to improve the health of transgender women: Protocol for a prospective longitudinal cohort study. JMIR Research Protocols. 2019;8(6):e14091.

33.   Mayo-Wilson L, Benotsch E, Grigsby S, et al. Combined effects of gender affirmation and economic hardship on vulnerability to HIV: A qualitative analysis among US adult transgender women. BMC PUBLIC HEALTH. 2020;20(1):782-717.

34.   Reisner S, Bradford J, Hopwood R, et al. Comprehensive transgender healthcare: The gender affirming clinical and public health model of Fenway Health. Journal of Urban Health. 2015;92(3):584-592.

35.   Reisner SL, White Hughto JM, Pardee D, Sevelius J. Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. International journal of STD & AIDS. 2016;27(11):955-966.

36.   Sevelius J. Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11-12):675-689.

37.   Sevelius JM, Chakravarty D, Dilworth SE, Rebchook G, Neilands TB. Gender Affirmation through Correct Pronoun Usage: Development and Validation of the Transgender Women's Importance of Pronouns (TW-IP) Scale. International journal of environmental research and public health. 2020;17(24):9525.

38.   Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. 2016.

39.   Dubin SN, Nolan IT, Streed CG Jr, Greene RE, Radix AE, SD M. Transgender health care: improving medical students' and residents' training and awareness. Adv Med Educ Pract. 2018;9:377-391.

40.   Sevelius J, Neilands T, Dilworth S, Castro D, Johnson M. Sheroes: Feasibility and acceptability of a community-driven, group-level HIV intervention program for transgender women. AIDS and behavior. 2019;24(5):1551-1559.

41.   Phillips II G, Raman A, Felt D, et al. PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2020;83(5):450-456.

42.   Reback CJ, Clark KA, Rünger D, AE F. A Promising PrEP Navigation Intervention for Transgender Women and Men Who Have Sex with Men Experiencing Multiple Syndemic Health Disparities. J Community Health. 2019;44(6):1193-1203.

43.   Cahill SR, Keatley J, Wade Taylor S, et al. "Some of us, we don't know where we're going to be tomorrow." Contextual factors affecting PrEP use and adherence among a diverse sample of transgender women in San Francisco. AIDS care. 2020;32(5):585-593.

44.   Maiorana A, Sevelius J, Keatley J, Rebchook G. “She is like a sister to me”: Gender-affirming services and relationships are key to the implementation of HIV care engagement interventions with transgender women of color. AIDS and behavior. 2020.

45.   Poteat T, Malik M, Scheim A, Elliott A. HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action. Current HIV/AIDS Reports. 2017;14(4):141-152.

46.   Gamarel KE, Sevelius JM, Neilands TB, et al. Couples-based approach to HIV prevention for transgender women and their partners: study protocol for a randomised controlled trial testing the efficacy of the ‘It Takes Two’intervention. BMJ Open. 2020;10(10):e038723.

47.   Reisner SL, Jadwin-Cakmak L, Sava L, Liu S, Harper GW. Situated Vulnerabilities, Sexual Risk, and Sexually Transmitted Infections' Diagnoses in a Sample of Transgender Youth in the United States. AIDS Patient Care STDS. 2019;33(3):120-130.

48.   Lacombe-Duncan A, Logie CH, Newman PA, Bauer GR, Kazemi M. A qualitative study of resilience among transgender women living with HIV in response to stigma in healthcare. AIDS Care. 2020;32(8):1008-1013.

 

Resource

Hermanos de Luna y Sol

An Empowerment HIV Prevention Program for Spanish-Speaking Latino Gay/Bisexual Men

Latino gay/bisexual men in the U.S. have been highly and disproportionately affected by the AIDS epidemic. The program "Hermanos de Luna y Sol" (HLS) was designed as a culturally-appropriate HIV risk-reduction intervention that targets immigrant, Spanish-speaking gay/bisexual men in the San Francisco, CA Mission district. The aims of the program are the following:

  • Provide experiences of social support, social belonging, and enhanced self-esteem in the context of a Latino gay identity and community;
  • Promote critical awareness of social and cultural forces that impact and shape participant's social and sexual lives'
  • Increase participant's sexual self-knowledge, with particular emphasis on sexual contexts and situations of personal vulnerability that limit participants' ability to practice safer sex, and:
  • Facilitate community involvement and activism to support a sense of increased personal agency and self-efficacy (instead of fatalism and victimization) in response to oppressive social forces in participants' lives.

Based on research findings about Latino gay/bisexual men, Bandura's theory of self-regulation, and principles of empowerment education, HLS aims to intervene in a culturally-appropriate manner with four factors that weaken the enactment of safer sex intentions:

  • low self-esteem
  • perceptions of low sexual control
  • lack of social support
  • fatalism regarding inevitability of HIV infection

By providing opportunities for group reflection and critical self-observation within the domain of sexuality, by providing a network of peer social support for the practice of safer sex, and sponsoring activities that support self-esteem and pride for being Latino and gay/bisexual, the program intervenes with and attempts to modify factors that promote HIV risk behavior in this particular population.

Intervention

HLS consists of three types of interrelated interventions. Please see detailed descriptions of the program activities.

  1. Bar outreach and recruitment activities;
  2. Six-week initial discussion workshops with structured sessions designed to promote self-esteem, social support and sexual self-regulation; and
  3. A set of follow-up resources and activities targeted to the maintenance of safer sex behavior over time, including participation in ongoing peer support groups, specialized workshops and retreats, and access to individual risk reduction counseling services.

Testimonies of participants' reactions to the program

Research

We are conducting an ongoing evaluation of the program, including quantitative data on participants' satisfaction and the program's impact on self-esteem, social support, self-efficacy, perceptions of sexual control, and safer sex behavior. Also, San Francisco State University's César E. Chávez Institute has more information about Hermanos de Luna y Sol.

Resource

Fall/Winter 2016 [E-Newsletter]

NIMH re-funds CAPS for another five years & CAPS 30th Anniversary!

Welcome to our 2nd quarterly e-newsletter! This issue highlights new research projects from CAPS VII,the CAPS 30th Anniversary Celebration, and NIMH re-funding for another 5 years. Updates include our newly funded research, updated fact sheet on stigma, the launch of the new CAPS/PRC website, awards, and new staff! In this issue:
  1. CAPS 30th Anniversary
  2. NIMH re-funds CAPS for 5 years
  3. New California Projects
  4. New International Projects
  5. Featured: Updated fact sheet on stigma and HIV prevention
  6. New website launch
  7. Announcements
Resource

Latino gay men in the US

The ever changing mosaic of Latino demographics in the US creates unique challenges to address health disparities of the population, especially when it comes to HIV prevention needs. Latinos are the largest and fastest growing ethno racial minority group in the US, experiencing a 43% growth between 2000 and 2010. Data also show that Latinos are one of the fastest growing populations at risk for HIV transmission:
  • Latino men who have sex with men (MSM*) represent 81% of new infections among Latino men, and 19% among all MSM2
  • Latinos are 16% of the US population, but make up 17% of living HIV/ AIDS cases and 20% of new HIV infections each year
  • Youth (ages 13-29) accounted for 45% of new HIV infections among Latino MSM. In light of these data there is a need to identify culturally-specific health concerns of Latino gay men so that effective interventions may be developed to address current and prevent future disparities.
The US National HIV/AIDS Strategy highlights the call for HIV programs that reduce health inequities among both ethnoracial and sexual minority populations. Latino gay men have distinct cross-cultural identities that place them into both prioritized categories.