This study seeks to address two pressing scientific needs: 1) to improve ways to sample and recruit hard-to-reach minority populations for inclusion in research and 2) to fill a gap in our knowledge of the health problems faced by female-to-male transgender persons (transmen). Minority populations unduly suffer from many diseases and mental health conditions;sexual minorities bear a particularly heavy burden of the HIV epidemic. We are seeing warning signs that transmen may be an overlooked minority population at high risk for HIV, with documented AIDS and STD cases, sex partners who are gay men and male-to-female transgender persons (transwomen) and low condom use. Transmen also appear to face discrimination and have high levels of drug and alcohol use, depression and suicide. However, reliable data are lacking to guide prevention and care programs. This exploratory study will develop and test a novel strategy to sample and recruit transmen for a survey of HIV prevalence and health risks, beginning with outreach to public places where transmen are found followed by referral of their peers. Although this study focuses on transmen, our research will invent and validate a new sampling method applicable to diverse populations affected by HIV and other health issues worldwide.
Transmen may be at high risk for HIV infection yet there is an extreme paucity of accurate data from representative samples. The primary significance of this proposed R21 is that it will develop and apply a new sampling method to obtain more representative health data on transmen. Our strategy is to assess the theoretical assumptions underlying venue-outreach and peer-referral sampling methods and combine their advantages in the field. We anticipate findings of this exploratory study will be immediately applicable to advocate for HIV prevention resources, develop appropriate new interventions and guide future research on this marginalized population. Our study also stands to enhance the inclusion and representation of other minority populations in research and provide more rigorous data from groups experiencing diverse health disparities.