Findings and Lessons Learned about the Use of Imagery in Health Communication Efforts for Transgender People from Act Against AIDS and Other Health Communication Efforts

Background:  Effective social marketing and other health communication efforts include images appropriately reflecting all audience segments. Efforts targeting transgender people that feature empowering and affirming images of transgender people support the creation of effective communication products while reducing unintended consequences, such as felt or enacted stigma. 

Program background:  The CDC has multiple HIV prevention communication efforts, including Act Against AIDS (AAA), an umbrella initiative consisting of a suite of communication campaigns, and the HIV Risk Reduction Tool (HRRT), a web-based application providing comprehensive, tailored HIV prevention information to the public. Transgender people, especially transgender women of color, are at disproportionate risk for HIV and are, therefore, an important audience segment for AAA and HRRT. Efforts to expand transgender representation across communication efforts involved extensive formative research and stakeholder engagement, and resulted in imagery that can be used across projects and channels.

Evaluation Methods and Results:  We explored imagery through multiple formative research activities. We collected data to understand the barriers and facilitators to accessing HIV services for transgender people that included engagement of an advisory group of community-based providers, clinicians, researchers, and other key stakeholders, interviews with key informants (N=9), and interviews with healthcare providers that serve transgender people (N=9).  We conducted a round of usability testing with self-identified transgender people to inform updates to the HRRT Beta Version (N=9). We tested images from a transgender healthcare provider resource kit with clinicians (N=9) and with transgender women of color (N=9) and gathered feedback from advisory group members on the kit (N=7). We also tested executions of transgender women from the AAA HIV testing campaign, Doing It, with transgender women (N=4). Results of formative research identified a need for HIV prevention campaigns designed specifically for transgender women that show empowering and affirming images and models positive interactions between transgender people and their healthcare providers. Transgender participants reviewed images of cisgender men and women for the Beta HRRT and reported not feeling represented by the images, indicating that communication products should not solely rely on images of cisgender people to represent transgender people. Results from resource kit testing demonstrated that transgender women appreciated seeing images of other transgender women in campaigns. Feedback also indicated that images need to include more variation of transgender people in terms of race/ethnicity and gender expression and need to be designed so as not to stereotype transgender people.

Conclusions:  Imagery is a powerful way to increase message resonance, which occurs when people see themselves reflected in campaigns and communication products. Transgender people are a critical group to reach through HIV prevention efforts. It is critical, however, to not only include them in campaigns but also to ensure that images reflect the diversity of transgender people while normalizing and de-stigmatizing their experience. 

Implications for research and/or practice:  More research is needed to test a wider range of images of transgender people, representing different racial and ethnic groups and gender expression, including transgender men, and gender non-conforming people. Testing of additional images needs to be conducted with transgender people representing multiple groups.