Introduction One of the biggest threats to the health of trans*females is HIV, particularly for those who are part of racial/minority groups. Yet health disparities for racial/ethnic minority trans*female youth remain understudied. Methods We examined baseline data from 282 trans*female youth ages 16–24 years old in the San Francisco Bay Area. We conducted Chi-squared tests for distributional differences between racial/ethnic minority and white participants in socio-demographic factors, HIV-related risk behaviors and syndemic factors. Results A total of 4.8% of trans*female youth were HIV positive. Racial/ethnic minority and white trans*female youth differed significantly in their gender identities and sexual orientations. Racial/minority youth also had significantly lower educational attainment, were less likely to live with their parents of origin as a child, and were significantly more likely to engage in recent condomless anal intercourse compared to whites. Conclusions Important disparities in HIV-related sexual risk behavior, education, and residential stability exist between racial/ethnic minority and white trans*female youth. Efforts to assess the impact of multiple minority stress for racial/minority trans*female youth are imminently needed. Additionally, macro-level disparities must be addressed in prevention efforts for trans*female youth, especially for those from racial/ethnic minority groups, in order to prevent incident cases of HIV and reduce disparities.

Background Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. Objective We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. Methods A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. Results Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. Conclusions Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodolo...

IntroductionTransfemale youth (TFY) are an underserved and understudied population at risk for numerous poor physical and mental health outcomes, most notably HIV. Research suggests that parental acceptance and social support may serve as protective factors against HIV and other risks for TFY; however, it is unclear whether TFY receive primary social support from parents with or without parental acceptance of their gender identity. This study examines differences in parental acceptance, mental health and the HIV risk factors of history of sex work, age at sexual debut and engagement in condomless anal intercourse between TFY with two types of primary social support – non-parental primary social support (NPPSS) and parental primary social support (PPSS).MethodsCross-sectional data collected from 301 TFY from 2012 to 2014 in the San Francisco Bay Area were analyzed to determine differences in parental acceptance, mental health and HIV risk factors between youth with and without PPSS. Univariate statistics and chi-squared tests were conducted to determine if parental acceptance and health outcomes were correlated with type of social support.ResultsTwo-hundred fifty-one participants (83.7%) reported having NPPSS, and 49 (16.3%) reported PPSS. Significantly more youth with PPSS reported affirmative responses on parental acceptance items than their NPPSS counterparts. For example, 87.8% of youth with PPSS reported that their parents believed they could have a happy future as a trans adult, compared with 51.6% of youth with NPPSS (p<0.001). Fewer participants with PPSS reported symptoms of psychological distress (2.0% vs. 12.5%, p=0.057), though this finding was not statistically significant; no significant associations were found between primary social support type and HIV risk factors.ConclusionsThese results suggest that TFY with parental acceptance of their gender identity may be more likely to reach out to their parents as their primary source of social support. Interventions focused on parental acceptance of their child's gender identity may have the most promise for creating parental social support systems in the lives of TFY.

Background Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. Objective This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Methods This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. Results The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ21=4.68, P=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. Conclusions Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. International Registered Report Identifier (IRRID) RR2-10.2196/16406

BackgroundYoung racial and ethnic minority men who have sex with men (MSM) and trans women are disproportionately affected by HIV and AIDS in the United States. Unrecognized infection, due to a low uptake of HIV testing, and poor linkage to care are driving forces of ongoing HIV transmission among young racial and ethnic minority MSM and trans women. Internet and mobile technologies, in combination with social network-based approaches, offer great potential to overcome and address barriers to care and effectively disseminate interventions.ObjectiveWe describe Health eNavigation (Health eNav), a digital HIV care navigation intervention that extends supportive care structures beyond clinic walls to serve youth and young adults living with HIV who are newly diagnosed, not linked to care, out of care, and not virally suppressed, at times when they need support the most.MethodsThis study leverages ecological momentary assessments for a period of 90 days and uses person-delivered short message service text messages to provide participants with digital HIV care navigation over a 6-month period. We aim to improve engagement, linkage, and retention in HIV care and improve viral suppression. Digital HIV care navigation includes the following components: (1) HIV care navigation, (2) health promotion, (3) motivational interviewing, and (4) digital social support.ResultsRecruitment began on November 18, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on October 31, 2019. In this paper, we present baseline sample characteristics.ConclusionsWe discuss real-world strategies and challenges in delivering the digital HIV care navigation intervention in a city-level, public health setting.International Registered Report Identifier (IRRID)DERR1-10.2196/16406