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Background:TRIUMPH (Trans Research–Informed communities United in Mobilization for the Prevention of HIV) was a community-led, transgender-specific pre-exposure prophylaxis (PrEP) demonstration project at 2 community-based clinical sites in California. TRIUMPH used peer health education, community mobilization, and clinical integration of PrEP with hormone therapy to promote PrEP knowledge and acceptability. The goal of this study was to evaluate PrEP uptake, retention, and adherence among TRIUMPH participants and examine site-based differences.Methods:Eligible participants were adult transgender and gender diverse people interested in PrEP. Participants were seen at baseline and at 1, 3, 6, 9, and 12 months for PrEP provision, clinical visits, and HIV testing. PrEP uptake was defined as dispensation of PrEP, PrEP retention was defined as proportion of expected visits completed among those who initiated PrEP, and PrEP adherence was assessed by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models quantified the association of variables with PrEP outcomes.Results:TRIUMPH enrolled 185 participants; the median age was 28 years (interquartile range: 23–35), 7% was Black, and 58% was Latinx. PrEP uptake was as follows: 78% in Oakland and 98% in Sacramento; 91% among trans women, 96% among trans men, and 70% among nonbinary participants. Almost half (47%) rarely/never believed about HIV, and 42% reported condomless sex act in the past 3 months. Participants who reported higher numbers of sex partners were more likely to be retained and adherent; other predictors of adherence included not having a primary partner and not experiencing violence in the past 3 months.Conclusions:This community-led, trans-specific PrEP demonstration project documents high levels of PrEP initiation in a young transgender and gender diverse cohort at risk of HIV acquisition.

Research has documented associations between relationship stigma, relationship quality and adverse health outcomes among sexual and gender minority couples. However, this work focused primarily on one aspect of an individual's or a couple's identity rather than understanding the intersections of multiple, stigmatized social identities. As part of a larger project focused on testing the efficacy of a couples-based intervention to improve HIV medication adherence, 144 couples completed measures of relationship stigma, relationship quality, mental health, and substance use. A subset of 25 participants completed in-depth interviews to better understand the phenomenon of relationship stigma and its impact on their relationships. Quantitative results demonstrated that greater relationship stigma was associated with reduced relationship satisfaction and commitment, as well as greater closeness discrepancy and depressive symptoms. Qualitative findings provided nuanced insights into forms of relationship stigma that often intersected with other types of stigmaThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

There is evidence for a relationship between housing instability and transactional sex among transgender women. However, less is known about this relationship among monolingual Spanish-speaking transgender women. We compared Spanish- and English-speaking transgender women for differences in ever reporting transactional sex, and if perceived housing stability moderated these differences. Using a cross-sectional design, we surveyed 186 Spanish- and English-speaking transgender women in Philadelphia, Pennsylvania, and the San Francisco Bay Area, California. All variables in this study were from a brief demographic questionnaire in a larger parent study. Using a multivariate regression model for moderation, we tested whether the odds for reporting transactional sex were different between English and Spanish speakers, and whether housing stability moderated these odds. Overall, Spanish and English speakers reporting similar percentages of transactional sex (52.3–53.8%) and similar scores on the housing stability measure. In the moderation regression model, Spanish speakers had 7.9 times the adjusted odds of transaction sex, versus English speakers, but housing stability moderated the probability of transactional sex in the form of a crossover interaction. That is, lesser housing stability was associated with a higher probability of reporting transactional sex among Spanish speakers, yet greater housing stability was also associated with lower probability of reporting transactional sex. Housing stability evidenced both a risk and protective role for Spanish-speaking transgender women, which highlight the importance of this basic health need.

Background: Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx project staff led intervention development, which aimed to increase access to HIV prevention services, including PrEP. Methods: This paper engages qualitative methods to describe and evaluate how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of participant observation of intervention activities and recorded field notes. We analyzed qualitative data engaging a content analysis approach and used Dedoose to code transcripts. Results: Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support “entre nosotras” (“between us women/girls”). The combination of these factors contributed to the intervention’s success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcomed and “en casa/ at home” in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. Peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. Conclusions: Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.