mHealth for transgender and gender-expansive youth: harnessing gender-affirmative cross-disciplinary innovations to advance HIV prevention and care interventions

Abstract

Transgender and gender-expansive (TGE) youth endure stark disparities in health and wellbeing compared to their cisgender peers. A key social determinant of health for TGE adolescents and emerging adults is gender affirmation, which encompasses multidimensional validations of an individual's lived gender. Lacking available resources for one's gender affirmation, TGE young people may engage in highrisk maladaptive coping behaviors, linked to their disproportionately high HIV-acquisition risk. A range of innovative mobile technologies are guided by the Gender-Affirmative Framework to promote the health of TGE communities, including through HIV prevention and care continuum outcomes. The aim of this review was to examine key features of existing mobile technologies that can be leveraged to advance the field of TGE-responsive mHealth. We systematically searched scientific records, gray literature, and the iOS and Android app distribution services. To be eligible, platforms and interventions needed to be tailored exclusively to a TGE user base, incorporate gender-affirming features, and be optimized for or adaptive to mobile technologies. Eligible interventions (N=24) were compared on evidence of utility, core functionalities, and dimensions of gender affirmation. Smartphone applications (apps) and webapps (n=16) were the most common delivery modality. Many interventions (n=9) aimed to address HIV-related outcomes and integrated gender-affirmative features. The most common gender-affirmative features originated in fields of human-computer interactions and informatics, or were crowdfunded by TGE developers. HIV-focused interventions incorporated evidence-based health behavior change strategies and utilized rigorous evaluation methods. Across modalities and disciplines, behavioral self-monitoring and access to HIV prevention services were the most frequent features. Over two-thirds of the interventions reviewed aimed to provide medical gender affirmation (e.g, provided guidance on obtaining medically sanctioned hormone therapies, or safely practicing non-medical options such as chest-binding) or psychological gender affirmation (e.g, provided linkage to mental health counseling). Our results show that mHealth and other technology-mediated interventions offer a diverse range of both evidence-based and innovative features; however, many have not been rigorously evaluated in a randomized controlled trial to support TGE users. A continuing commitment to evidence-based health behavior change strategies, exemplified by the HIV-focused interventions included in this review, is essential to advancing gender-affirmative mHealth. The unique and highly innovative features of platforms originating outside the fields of HIV prevention and care suggest new directions for TGE-responsive mHealth, and the need for more conscientious models of knowledge exchange with investigators across scientific disciplines, private-sector developers, and potential users. mHealth, 2021

Protocol for a scoping review of the use of information and communication technology platforms for the delivery and utilisation of transgender healthcare

“… 32 Telemedicine services that include the use of videoconferencing have been a useful tool for providing postoperative care to individuals who undergo gender affirmative surgeries, 33 particularly in situations where access is impeded, such as during the COVID-19 pandemic. 34 Additionally, telemedicine has helped to overcome the stigma barrier when it comes to HIV/STI screening/care among transgender populations. 35 36 …”

mHealth for transgender and gender-expansive youth: an update on COVID, venture capital, and the cultural in/congruence of revenue-driven sustainability models

“…for the cost of a monthly out-of-pocket subscription fee: $100/month, approximately, not including the cost of medication (5). The Solace app, covered in Skeen et al (1), is now the flagship offering of VC-backed Euphoria.LGBT Inc., which is developing a suite of TGE-tailored apps. The amounts invested toward their eventual profitability are non-trivial: $29,400,000 to Folx Health across seed, venture, and Series A funding rounds; $14,000,000 raised by Plume in a Series A round; and $580,000 to Euphoria.…”

“…*, as in our earlier review(1), we replace "medical affirmation" with "embodied affirmation" in order to capture bodily interventions, such as chest-binding and electrolysis, accessible in non-medical settings.Evidence summaries are as of February 2022. Results are limited to English-language (partially, or in full) platforms and records.…”

“…ICTs permit socially isolated users to transcend the limitations of their physical environments, in which TGE social bonds, gender-affirming hormone therapy (GAHT) providers, or physical safety, may be lacking. This is particularly true of TGE youth, who may lack autonomy or in-person support ( 1 ). A diverse, innovative range of ICT interventions serves the gender-affirmation needs of TGE users.…”

“…A diverse, innovative range of ICT interventions serves the gender-affirmation needs of TGE users. As noted by Skeen et al ( 1 ), these interventions can be classified along distinct lineages: (I) academic medicine, often via NIH-funded clinical trials; (II) human-computer interaction, user experience (UX) design, and adjacent subfields; and (III) TGE-led community technologies, often developed via hackathons and crowdfunding.…”