1. Delivery of DEBIs to Young Transgender Persons
of Color by Communit y-Based Organizations:
Operational Research to Strengthen Program
Implementation
Melanie L. Sovine,1 Deborah J. Gelaude,2
Robert Swayzer III1 & Jeffrey H. Herbst 2
1PreventionPrograms Branch, DHAP NCHHSTP
,
2Prevention Research Branch, DHAP NCHHSTP
,
2011 National HIV Prevention Conference, Atlanta, GA
Session D30: Expanding Evidence-based HIV Prevention Activities
among Transgender Persons
Monday, August 15, 2011 (10:30am-12:00pm)
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

2. Disclaimer
The findings and conclusions in this presentation are those of
the authors and do not necessarily represent the views of the
Centers for Disease Control and Prevention.

3. Purpose of the Presentation
 Identify key operational issues influencing
HIV prevention program implementation
with young transgender (YTG) persons of
color

4. Epidemiological Background
 Transgender (TG) persons in the US are among the groups at highest
risk of HIV infection
 2008 meta-analysis of 29 published studies found HIV sero-positivity
rate among African American TG women (56%) 3 times higher than
rates among Latino (16%) and white (17%) TG women1
 African American TG women are more likely to become newly
infected with HIV2
 TG persons experience social isolation, stigma, and discrimination
which can increase their likelihood for engaging in unsafe behaviors
and presents unique challenges for HIV prevention service providers1
 TG persons are referenced as a priority population in the National
HIV/AIDS Strategy (NHAS)
1Herbst et al. (2008) AIDSBehav 2Sanchez et al. (2010) AIDSBehav

5. CDC Cooperative Agreement PS06-618
 In 2006, CDC funded 29 CBOs to deliver HIV prevention
programs to high-risk young men of color who have sex
with men (YMSM) and young TG persons of color (YTG)
 Grantees received financial and technical assistance to
deliver evidence-based behavioral HIV prevention
interventions and public health strategies (i.e., CRCS &
CTR)

6. CBOs Funded to Deliver Programs
to YTG Persons of Color
 Five CBOs funded to deliver HIV prevention programs for YTG of color
aged 13 to 24
 All programs served male-to-female TG persons
 All located in urban areas with high HIV/AIDS incidence and
prevalence among YMSM (statistics not available for TG populations)
 Chicago, Washington D.C., Pheonix, San Juan PR, San Francisco
 Implemented 2 DEBIs:
 SiSTA (2 CBOs)
• Group-level, for AA women, focus on ethnic/gender pride
• Adapted to TWISTA, adapted in Spanish
 Mpowerment (3 CBOs)
• Young gay/bi men of diverse backgrounds, builds positive
social relationships
• Adapted for transgender persons

7. Methods
 Qualitative review:
 4 years of annual progress reports (APRs) submitted to
CDC as part of required reporting process
• Text was abstracted and synthesized using a content analysis
approach to identify main challenges and successes around
intervention implementation
 Review of additional documentation:
• Site visit reports compiled by CDC Project Officers
• Internal CDC communications
• Interim progress reports
• Technical assistance and monitoring reports

8. Methods (continued)
Review Identify Abstract Code Analyze
• Read, • Identify • Abstract • Create • Generate
review, major text on codebook reports on
and meet themes identified defining & coded
to discuss present in themes refining themes
content APRs into themes • Hypothesize
of APRs EZ-Text • Code patterns &
database sample of relationships
APRs among
• Determine themes
inter-coder • Report on
reliability findings
• Apply • Themes
codes for identified in
themes Nvivo 8
across all
APRs
8

9. Results
Key operational issues:
 Collaborations & partnerships
 Engaging TG community
 Expanded services
 Safe space
 Agency staffing
 Social inequality & transphobia

10. Collaborations & Partnerships
 Challenge for agencies to meet YTG basic needs:
• Mental health, housing/homelessness, education, & other
health concerns (like transitioning)
• Agencies could not meet all needs, so must collaborate &
partner with other providers -- not always easy
 Creating community
• Agency needs to earn trust with YTG community
• YTG needs continually changing, evolving, & requiring
ongoing assessment & adaptation of program and staff
 Accountability of program to collaborators &
community
• Involvement with community essential
 Even with all this, still may have challenges recruiting
participants

11. Selected Quote
 “ Collaborative relationships with other
communit y organizations and existing
partnerships…allow(s) for better
outreach to providers offering services to
youth….”

12. Engaging TG Communit y
 Building trust is not one time thing but ongoing &
evolving
 Strong ethic of protecting YTG by larger TG community
 Sensitivity to cultural needs & distrust important
 Continuous assessment of community needs is essential
 Involve community in program, not just target as
participants
 Understand role of older TG persons as mentors
 Employ community members as staff
 Fully involve gatekeepers

13. Selected Quote
 “ The inclusion of gatekeepers as
volunteers in our retreats has been an
excellent tool…mostly in recruitment for
the intervention.”

14. Expanded Services
 Provide services to meet basic health, mental health,
education, shelter, safety & employment needs
 Address service gaps for community
 Transitioning, medical source for hormone therapy, trauma &
psychosocial consequences of victimization & violence
prevention
 Communication & open dialogue important –
transparency essential

15. Selected Quotes
 “ We’ve found that often the greatest barrier
that prevents young TG women of color from
engaging in HIV prevention behaviors is that
they regularly do not have access to their basic
human needs…and often experience an
increased rate of trauma…By positioning [our
program] within a spectrum of services, YTG
women of color are able to be provided
with…services that meet their basic needs….”

16. Safe Space
 Importance of providing safe place for YTG to visit
 A huge incentive
 Safety is critical
 Can be a logistical challenge to create & manage
 Identifying appropriate locations
 Property management responsibilities
 Negotiating rental agreements

17. Selected Quotes
 “ The youth center is a welcoming,
supportive and safe environment
for…transgender youth. Its goal is to
create a space for honest, creative
expression – a place where youth can tell
their stories in their own words without
fear of being judged.”

18. Staffing
 Engaging & maintaining youth as staff
 Competing needs
 Age & maturity
 Staff need specialized training
 Social and sexual ethics when working with peers
 Trauma management, suicide prevention
 Youth development – cognitive & emotional developmental
stages impact maturity, engagement, & successful involvement in
programming
 YTG staff essential for program success
 Providing peer-to-peer HIV prevention awkward for some youth
 Staff as mentors
 1-on-1 relationships

19. Selected Quotes
 “ Most people assume that the same skills
are utilized between high-risk adults and
high-risk youth – this could not be further
from the truth. Finding staff with the
abilit y to offer positive youth
development in a sex positive
environment with cultural sensitivit y is a
very unique set of skills.”

20. Social Inequalit y & Transphobia
 Impacts ability to trust service providers
 Importance of involving community gatekeepers
 Incentives essential, especially for meeting basic needs beyond
HIV prevention
 Anticipating future needs important
 Restricting program to youth only
 Did not engage older TG women
 Terminology & definitions – need for an agreed upon
language
 Very young are pre-transition, did not always identify as TG

21. Selected Quotes
 “ In addition to providing emotional
support, referrals to lawyers and liaisons
with the police, and mental health
referrals…the facilitators have led
discussions regarding fears, and
strategies for remaining safe.”

22. Discussion
 Providers identified key operational issues that influence their ability
to provide HIV prevention services to YTG persons of color
 Voices of the service providers in this analysis reflect an earlier
emphasis on behavioral HIV prevention interventions (DEBIs)
 These voices are still instructive for the more recent emphasis on
structural and biomedical interventions
 Sexual health
 Education, employment, housing/food & medical care
 Discrimination, violence & stigma
 Findings are consistent with studies in the literature suggesting
“multicomponent interventions are necessary to respond to the
complex interacting syndemic factors that cumulatively determine
HIV vulnerability in TG individuals” 1
1Operario & Nemoto, 2010 JAIDS

23. Limitations
 Data from funder-driven reporting requirements
 May not fully represent provider experience
 Only 5 agencies implementing 2 DEBIs
 Limited generalizability
 Analysis would be strengthened by integrating voices
from YTG persons served

24. Acknowledgements
 CBO Providers
 PPB Project Officers
 CDC Project Staff
 Camilla Harshbarger
 Arin Freeman
 Monique Carry

25. Thank You!
For more information please contact:
Melanie L. Sovine , PhD Deborah J. Gelaude, MA
msovine@ cdc.gov dgelaude@ cdc.gov
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

26. All sites were funded under CDC
cooperative agreement PS06-618:
Human Immunodeficiency Virus (HIV)
Prevention Projects for Young Men of
Color Who Have Sex with Men and Young
Transgender Persons of Color