The majority of new HIV cases in the US occur among youth under 25 years old. Among infected youth, most are part of marginalized populations. Transgender female youth are a stigmatized and marginalized youth population disproportionately at risk for HIV. The two HIV risk studies of transgender female youth to date have found that one in five are HIV-infected before the age of 25. In San Francisco, transyouth have the highest HIV prevalence of any population, the highest proportion of AIDS cases among youth, and the fastest rate of death due to AIDS in the city. Despite their extraordinary risk for HIV, transgender female youth are understudied in the scientific literature. Gaps in the data exist due to cross-sectional study designs with convenience samples of transyouth who represent only the most risky sub- populations. In part due to these gaps, to date there are no HIV prevention interventions that have been developed specifically for this population. We propose to conduct a longitudinal qualitative and epidemiological study of 300 transgender female youth ages 16-24 years to examine HIV-related risk behaviors and identify protective factors for resilience. We will reach and retain participants by taking an innovative approach to adapting respondent driven sampling using socially interactive technologies.
The Specific Aims of this application are to adapt and refine measures of protective factors and to explore resilience among transyouth, determine risk factors specific to development that explain engagement in HIV-related risk behaviors among transyouth, and identify protective factors for HIV-related risk behaviors among transyouth. The methods to be investigated, refined, and applied for this research are critical to the evidence base of HIV prevention for diverse populations of MSM and other marginalized groups. This proposed project will fill important gaps in the literature by providing the first set of causal data from a diverse, representative sample of transyouth addressing both the challenges this population faces and the strengths they possess to ultimately intervene to reduce HIV infection.

Public Health Relevance

ffective interventions are needed to reduce behavioral risk for HIV among marginalized populations of MSM, including transgender female youth. Our goals are to determine the factors most contributing to HIV risk for transgender female youth and identify protective factors that can be utilized in interventions targeting this disproportionately affected community. These findings will ultimately be translated in into concepts appropriate for the design of effective interventions for HIV prevention within this population.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-D (02))
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Allison, Susannah
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Public Health Foundation Enterprises
City of Industry
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Arayasirikul, Sean; Pomart, W Andres; Raymond, H Fisher et al. (2018) Unevenness in Health at the Intersection of Gender and Sexuality: Sexual Minority Disparities in Alcohol and Drug Use Among Transwomen in the San Francisco Bay Area. J Homosex 65:66-79
Johns, Elizabeth A; Jin, Harry; Auerswald, Colette L et al. (2017) Sociodemographic Factors Associated With Trans*female Youth's Access to Health Care in the San Francisco Bay Area. J Adolesc Health 61:259-261
Turner, Caitlin M; Santos, Glenn-Milo; Arayasirikul, Sean et al. (2017) Brief Report: Psychosocial Predictors of Engagement in Sexual Risk Behavior Among Trans*female Youth Aged 16-24 Years in San Francisco. J Acquir Immune Defic Syndr 74:258-264
Arayasirikul, Sean; Wilson, Erin C; Raymond, Henry F (2017) Examining the Effects of Transphobic Discrimination and Race on HIV Risk Among Transwomen in San Francisco. AIDS Behav 21:2628-2633
Wilson, Erin C; Chen, Yea-Hung; Arayasirikul, Sean et al. (2016) The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support. AIDS Behav 20:2203-2211
Le, Victory; Arayasirikul, Sean; Chen, Yea-Hung et al. (2016) Types of social support and parental acceptance among transfemale youth and their impact on mental health, sexual debut, history of sex work and condomless anal intercourse. J Int AIDS Soc 19:20781
Wilson, Erin; Chen, Yea-Hung; Pomart, W Andres et al. (2016) Awareness, Interest, and HIV Pre-Exposure Prophylaxis Candidacy Among Young Transwomen. AIDS Patient Care STDS 30:147-50
Arayasirikul, Sean; Chen, Yea-Hung; Jin, Harry et al. (2016) A Web 2.0 and Epidemiology Mash-Up: Using Respondent-Driven Sampling in Combination with Social Network Site Recruitment to Reach Young Transwomen. AIDS Behav 20:1265-74
Rowe, Chris; Santos, Glenn-Milo; McFarland, Willi et al. (2015) Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area. Drug Alcohol Depend 147:160-6
Wilson, Erin C; Chen, Yea-Hung; Arayasirikul, Sean et al. (2015) Connecting the dots: examining transgender women's utilization of transition-related medical care and associations with mental health, substance use, and HIV. J Urban Health 92:182-92

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