Findings and Lessons Learned about Creating Messaging for Transgender People from the Act Against AIDS Campaign and Other HIV Communication Efforts

Background: To develop effective communication tools and campaigns for HIV prevention, it is critical to create messages that are relevant and inclusive of all communities impacted by HIV/AIDS, including transgender people. Providing tailored messages through customizable content, engaging stakeholders and members of the target audience to identify appropriate language, and content are viable strategies to create health communication messages that resonate with a diverse audience.

Program background: Act Against AIDS (AAA) is a national initiative that combats HIV and AIDS among hardest hit populations. The HIV Risk Reduction Tool (HRRT) is an interactive website delivering comprehensive and customizable information about HIV risk and prevention, including messages tailored for transgender people. This presentation will discuss research findings used to inform the expansion of AAA and the development of HRRT.

Evaluation Methods and Results: During 2015 and 2016, CDC conducted research activities with transgender people and healthcare providers who serve the transgender community, including message testing (N=64), in-depth interviews (N=27), usability testing (N=9), key informant interviews (N=9), and consultations with subject matter experts. Findings were synthesized across all research activities to suggest best practices for producing targeted and inclusive messages for transgender people and individuals who provide healthcare services to the transgender community. Analysis of qualitative data revealed several consistent findings within and across the research activities. Data strongly suggests avoiding use of gendered descriptions in messaging (e.g., “male genitalia”). Although our gender lexicon is evolving, to increase relevance, messages should describe gender with categories used by the target audience (e.g. male, female, transgender, gender nonconforming). Additionally, receptivity and comprehension were highest among transgender participants when messages include scientific information and gender appropriate language. Our research also indicates the need for clear and audience-specific information about biomedical options to prevent HIV transmission and acquisition. In messages about medicines to prevent or treat HIV, healthcare providers and subject matter experts suggested including guidelines for prescription, patient eligibility, cost considerations, potential side effects and interactions, particularly with hormonal replacement therapy. Qualitative data and consultations revealed that messages describing health disparities among transgender people should also provide social context to reduce potential stigma. Healthcare providers and consultants highlighted the need for comprehensive messages about how to facilitate a gender-affirming environment, particularly in a healthcare setting. For example, the message may include information on how to train all staff on cultural humility, establish correct pronouns procedures during interpersonal communication, and incorporate gender identity questions into patient forms.

Conclusions:  To develop effective messages that resonate with transgender people, along with other members of the target audience, content should avoid using gendered descriptions, and describe gender categories using terms familiar to the target audience(s). Messages should also provide audience specific information about options to prevent HIV transmission and acquisition, while highlighting the need for gender-affirming environments, and framing health disparities within a social context.

Implications for research and/or practice: Health communicators should include transgender people and individuals who serve the transgender community in formative research activities to develop health communication campaigns and tools that aim to reach a diverse audience or target the transgender community.