Employment as HIV Prevention: An Employment Support Intervention for Adolescent Men Who Have Sex With Men and Adolescent Transgender Women of Color

Abstract

Background:The purpose of this study was to adapt and pilot-test an employment support, primary HIV intervention tailored to the needs of adolescent men who have sex with men and adolescent transgender women of color. Setting:The intervention was implemented in 2 settings: controlled environment (Phase 1) and real-world community-based (Phase 2) setting in Chicago, IL.Methods: Eighty-seven adolescent men who have sex with men and adolescent transgender women of color ages 16-24 participated in Work2Prevent, a 4-session employment and HIV prevention intervention, designed to increase job-readiness and reduce HIV risk. Intervention sessions consisted of group activities: educational games, roleplaying/modeling behavior, and self-regulation exercises.Participants were assessed at baseline, postintervention, and 8-month (Phase 1) or 3-month follow-up (Phase 2).Results: Participants evaluated Work2Prevent as feasible and acceptable, rating intervention quality, usefulness, and satisfac-tion highly. Overall, 59.6% (Phase 1) and 85.0% (Phase 2) participants attended 2 or more sessions. At 8 months, Phase 1 participants reported a mean increase of 11.4 hours worked per week. Phase 2 participants reported a mean increase of 5.2 hours worked per week and an increase in job-seeking self-efficacy. Phase 2 participants also reported a decrease in transactional sex work. Conclusion:Work2Prevent is one of the first structural primary HIV interventions to specifically focus on adolescent employment readiness. Findings suggest Work2Prevent is feasible and acceptable, improved adolescent employment outcomes, and reduced HIV risk associated with transactional sex work. Our study underscores the need for alternative pathways, such as addressing socioeconomic determinants, to prevent adolescent HIV infection.

Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020

“…In this analysis, limited significant superadditive interactions were found, although the majority were between structural syndemic conditions (e.g., superadditive interactions between experiencing homelessness and exchange sex on CAI prevalence among Black and White participants). These results underscore the importance of prioritizing HIV prevention interventions that address social determinants of health (e.g., housing and poverty) ( 32 , 35 ). Notably, the same combinations of syndemic conditions often resulted in a superadditive interaction for one racial and ethnic group and a subadditive interaction for another racial and ethnic group.…”

“…HIV behavioral interventions addressing risks associated with certain sexual behaviors, mental health symptoms, and substance use for transgender women have reduced behaviors associated with HIV transmission ( 56 – 60 ). Although limited, behavioral interventions designed to address psychosocial and structural syndemic conditions (e.g., homelessness, legal employment and income, and mental health symptoms among transgender women) also have indicated promising reductions in behaviors associated with HIV transmission ( 35 , 61 – 63 ). Findings indicated differences in prevalence of syndemic conditions and interactions between syndemic conditions on CAI by racial and ethnic group, suggesting that syndemic-focused interventions for transgender women should be tailored to racial and ethnic groups.…”