Our long-range goal is to reduce HIV infection and transmission among communities most at risk by (1) identifying gender-specific factors underlying the psychosocial context in which HIV risk occurs and (2) applying these findings to the development of innovative models for effective, targeted prevention interventions. For all populations, HIV risk-especially as manifested in sexual behaviors-intersects with people's gendered norms, expectations, and behaviors. This is particularly so, however, for members of the transgender community. Due to challenges with their gender identity, transgendered individuals have a heightened awareness of how gender attributions and expectations affect sexual behavior. This application will examine transgender people's experiences in both the male and female gender role to understand how gender structures HIV risk. The objective of this particular application is to qualitatively and quantitatively assess the relationship between specific gendered contextual factors and HIV risk in a transgender sample, thereby providing the basis for the development of a future intervention model for addressing gender-related prevention challenges of different at-risk populations. We will pursue the following three specific aims: (1) Qualitatively examine transgender people's experiences of how gender influences HIV risk; (2) Assess the empirical relationship between gender identity, social sex role, and HIV risk in a transgender sample; and (3) Determine the impact of gender-related stigma, shame, and affirmation and disclosure of identity on HIV risk and protective behaviors. Our cross-sectional study will employ a combination of Internet-based qualitative and quantitative methodologies to engage a national sample of transgendered individuals in semi-structured, in-depth online interviews (N=60) and an online survey (N=600). This study is expected to yield the following outcomes. First, it will increase our understanding of how gendered norms, expectations, and behaviors influence HIV risk, and importantly, which constructs deserve immediate testing in clinical settings and intervention programs. Second, tests for associations between gender-related constructs (crossgender identification and presentation, social sex role conformity, type of transgender identity, gender-related stigma, internalized transphobia, and affirmation of gender identity) and HIV risk will provide new means of identifying individuals at higher risk for HIV and with high likelihood of benefiting from targeted interventions focused on the underlying gender-based influences on their risky sexual behaviors. Notably, while this work is expected to directly benefit transgender individuals and their partners (who have been largely neglected in HIV prevention efforts), it will also provide an empirical basis (or additional hypotheses, research, and an intervention model targeting gender as a contextual HIV risk factor among other populations.
