Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 4;6(5):256-266.
doi: 10.1089/trgh.2020.0071. eCollection 2021 Oct.

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

Maria Zlotorzynska  1 , Travis H Sanchez  1 , Ayden I Scheim  2 , Carrie E Lyons  3 , Jessica L Maksut  3 , John Mark Wiginton  3 , Stefan D Baral  3
Affiliations

Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

Maria Zlotorzynska et al. Transgend Health. .

Abstract

Purpose: There is a need for ongoing behavioral surveillance of human immunodeficiency virus (HIV)/sexually transmitted infection (STI) risk among transgender women, using assessments adapted to this population. We therefore developed and piloted the Transgender Women's Internet Survey and Testing (TWIST) study, a cross-sectional behavioral survey of transgender women in the United States coupled with remote biospecimen collection and testing. Methods: Participants age 15+ were recruited by using social media advertisements. Participants were eligible to take the survey if they reported male sex at birth, identified as female or as a transgender woman, resided in the United States, and reported ever having oral, vaginal, or anal sex. We examined a number of behavioral indicators by age, county population density, and medical gender affirmation treatment, using multivariable regression modeling. A sample of respondents was invited to receive a home biospecimen collection kit for HIV/STI testing. Results: The 401 participants were mainly non-Hispanic white and younger than 25 years. Self-reported HIV prevalence was 1.3% (5/401), and almost half (47.1%, 189/401) did not know their HIV status. Receiving medical gender affirmation was strongly associated with past-year HIV and STI testing, independent of general health care engagement. Of the 155 participants invited to receive home biospecimen collection kits, 48 (31.0%) consented and of those, 21 (43.8%) returned specimens for testing. Conclusion: This pilot study successfully reached its recruitment target and generated useful behavioral measures from an online sample of transgender women. We anticipate that online recruitment combined with self-collection of biospecimens will serve as an innovative and scalable strategy for ongoing monitoring of HIV/STI behavioral trends among U.S. transgender women.

Keywords: HIV/AIDS; STI; behavioral surveillance; online methods.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Social media banner advertisements used to recruit TWIST participants. TWIST, Transgender Women's Internet Survey and Testing.
See this image and copyright information in PMC

References

    1. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91:915–921. - PMC - PubMed
    1. Baral SD, Poteat T, Strömdahl S, et al. . Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:214–222. - PubMed
    1. Nemoto T, Bödeker B, Iwamoto M, Sakata M. Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables. AIDS Care. 2014;26:434–440. - PubMed
    1. Reisner SL, Poteat T, Keatley J, et al. . Global health burden and needs of transgender populations: a review. Lancet. 2016;388:412–436. - PMC - PubMed
    1. MacCarthy S, Poteat T, Xia Z, et al. . Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations. Sex Health. 2017;14:456–468. - PMC - PubMed

LinkOut - more resources