Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

ABSTRACT

Despite disproportionately high HIV prevalence rates and high risk for HIV acquisition and transmission, trans women in the United States are less likely than other high-risk populations to be aware of their HIV status or to perceive HIV infection as a serious health threat. Furthermore, concurrently high rates of unstable housing, few legal employment opportunities, lack of social support, and distrust of social service providers limit trans women's interest in being or ability to be recruited by, retained within, or linked into HIV prevention and care services. This article provides an overview of the barriers that prevent many high-risk trans women from being recruited, linked, and retained within HIV prevention and care services and from accessing HIV testing services, and it discusses several strategies for overcoming these barriers. Best practices in working with high-risk trans women include hiring trans women indigenous to local trans communities, designing culturally specific recruitment and retention strategies including the creation of living “community maps” to ensure successful community outreach, the construction of a trans women–specific community advisory board to create dialogue with community stakeholders including consumers, and extensive cultural sensitivity training for staff and community collaborators to sensitize them to the specific needs of high-risk trans women participants.

Keywords:

• HIV
• linkage
• recruitment
• retention
• transgender women

Acknowledgments

The authors would like to thank the trans women of Los Angeles County who have been consumers of our service programs and participants in our research studies for the opportunity to work together for the past 20 years. Additionally, Dr. Reback would like to thank the many trans women staff for their tremendous dedication and service to high-risk trans women.

Funding

Dr. Reback acknowledges support from the National Institute of Mental Health (P30 MH58107).