Purpose: Transgender women experience significant health disparities, including increased risk of HIV infection. In this study, we examined the sexual health needs of transgender women in the context of their overall health and well-being and to identify overarching content framing strategies and content for a mobile health intervention. Methods: We conducted four focus groups and 20 individual in-depth interviews in the United States with racially and geographically diverse transgender women. Results: Four key themes were identified: structural factors as a central part of health; prioritization of transitionrelated care and mental health; the need for sexual health beyond preventing sexually transmitted infections and HIV; and the importance of connection and community. Conclusions: These themes can help inform the development of HIV prevention and sexual health promotion interventions for transgender women. The results suggest that the HIV and sexual health needs of transgender women should be addressed within the context of structural factors with a focus on resilience, community connection, and social support.
Background HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.
My cultural anthropology master's thesis focuses on the workings of InannaHouse, an emergency shelter/residential program for commercially sexually exploited (CSEC) youth in Portland, Oregon. In the summer of 2017, I did participant observation and interviewed youth and direct care staff members at the CSEC shelter I had been working at for 2 years. I begin by situating ideas about domestic minor sex trafficking (DMST) within larger historical, legal, economic, and political contexts. I consider concepts of childhood, race, class, gender, and sexuality on the story of DMST in the United States. Next, I explore the ways humans and institutions move around, and sometimes through, a shared human vulnerability. By considering the functions of trauma and CSE youths' experiences of resilience and relationship, I make a case for care based on interconnectedness. Using the lens of commensurability and social commensurability, I highlight how care oscillated between a disciplinary gaze and a deep relatability (Povinelli 2001; Garcia 2010). Further, I discuss how rules meant to consider trauma's impact on the mind and body of youth often faltered with inconsistency, forming traumatropisms instead of trauma-informed care (Feldman 2015). I draw out the evidence for the tangle of care and control in the shelter.In addition, I examine youth and staff experiences of living and working at Inanna House. I focus on how Inanna House used techniques of quasi-total institutions and disciplinary power along with tools of trauma-informed care to structure its program, and i ii how all three often fell apart (Goffman 1969; Foucault 1976). In the cracks of the crumbling foundational structures though, I bring into view instances of what I call 'becoming' (Deleuze 1997). Becoming refers to the ways both youth and staff disrupted roles based on discipline and control or being trauma-informed, and were more malleable, more desiring, and more unknown than the structures around them accounted for (Biehl and Locke 2017).Finally, I discuss the role of grief, often missing in the organization of care in institutions like Inanna House, as well as in the anthropology of violence working on identities and relations in the aftermath. I try through this thesis to express the complexities and connections, the messiness and tenderness, running through the relationships and institution of a shelter for commercially sexually exploited youth.First, I would like to give thanks to the hill behind my house along the Clackamas River.The entirety of my graduate studies, work at Inanna House, and writing of this thesis happened while I lived under the protection of this hill. My relationship with the dappled wooded space of the hill the past many years gave me sustenance, fortitude, and serenity that were absolutely fundamental to this project of being. It was the spring at the top of the hill that taught me how to sit with and honor grief, honor the sacred labor of creation, and honor the becoming that was unfolding. I want my thanks to go first to this place....
BACKGROUND HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. OBJECTIVE This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. METHODS We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. RESULTS Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. CONCLUSIONS This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.
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