Living in Stealth: A Grounded Theory Study of Transgender Women’s Barriers to HIV-Prevention Services and Interventions

Abstract

Background and Purpose:HIV infection is a health disparity among transgender women. Despite limited HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers.Methods:Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20–69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding.Results:A theory grounded in the data namedLiving in Stealthemerged that described this central phenomenon that underpinned the other main categories ofEncountering Social BarriersandEncountering Structural Barriers.Generating Ideas for Restructuring HIV-Prevention for Transgender Womenwas the final category in which participants provided ideas to overcome HIV-prevention barriers.Implications:Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.