Background: Transgender communities are at high risk for STDs, including HIV, and often face many barriers to accessing care.
Objectives: To understand the transgender community’s perceptions of health and healthcare, HIV and syphilis testing, and potential social marketing campaigns to inform the development of an HIV and syphilis home testing program and promotional campaign.
Methods: Twenty-eight transgender individuals participated in four focus groups (one each for men, youth, women in English, and women in Spanish) in Los Angeles in September, 2011. Groups were run by transgender moderators using a discussion guide designed by STD Program staff and a community advisory board. Groups were observed and videotapes were analyzed using a grounded theory approach.
Results: Participants reported significant barriers to healthcare access, including a lack of insurance and other resources and a shortage of “trans-educated” healthcare workers. HIV concern varied widely. Concerns and knowledge about syphilis were low, but increased after receiving information provided during the groups. A home test for HIV and syphilis was attractive to a significant number of participants, but perceived benefits were sometimes offset by issues of computer access, homelessness and confidentiality. Regarding campaign materials, there was a tension between wanting trans-specific ads and not wanting their community to be identified as high-risk for STDs and HIV.
Conclusions: A thoughtfully designed home test for transgender communities in Los Angeles has the potential to address disparate rates of STDs and HIV and a lack of access to care. Community members want a promotional campaign that is upbeat, and inclusive of the entire community, including both men and women.
Implications for Programs, Policy, and Research: Increased information about transgender experiences, attitudes and healthcare utilization can inform programs such as the home test and expand services for transgender clients.